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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS SELECTRICAL UTILITY REL&E FORM
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LOT
ADDRESS
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NO. METERS
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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
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LOT
ADDRESS
GAS
ELEC.
NO.
UNITS
NO. METER
OUTLETS
NO. METERS
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CMF 077146
CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS *ELECTRICAL UTILITY REL.SE FORM
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NO.
UNITS
NO. METER
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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
TRACT
LOT
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ELEC.
NO.
UNITS
NO.METER
OUTLETS
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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
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TWNEROR
ENANT
Costa
USE
CITY O
STATE CITY
LIC NO B LIC. NO. 19
N0. fi SLOGS.
rus EnT 139' x 359' NOWON LOT A
Separate permits are required for
electric, plumbing and heating work.
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1 hereby eck..lW9e that I haver l'nd stara
a thise9ree
nd tocomwith
Mat Me ebow information is corre e
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ell Issas repulatln9 building construction. and I Me" not amPloy
compensation laws ofF(�A,Ma
m r
any parson In violation of Ms workmen's
y
Sate of California.
TI
beroby cartny Met 1 am u.parly licensed es a cons ector under5tba
Bminesa and Professions Code, Division 3,Cbapm
State of California
9, and Mat such licenwt ere in full force and eHact, or 1famPtfrom
m. orPalnons of Ma St. of California Busmeuand
ProfessionsCo .Owlslo 3, Cbapar 9.
Sepneture of ��
P mlttas
U
TOTAL PAID ae�le'a
P.!borired A9
/
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y
VALUATIONTION 19 FOR
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0
FEE tXJLV:Tj-6,.J
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TOTAL PAID ae�le'a
• CITY OF COSTA MESA •
BUILDING DMSION
_ DEVELOPMENT SERVICES DEPARTMENT
°� PERMIT
(714)754-5273 • Fax (714) 754.1856
Job Address: 3025 CROYDEN BAY
Suite No
Vicinity:
Parcel Nunmber: 93758095
Applicant: RICE, ROBERT
Address:
Owner: ROY, LORRAINE
Address 3025 CROYDEN BAY
Contractor.
Address:
Arch/Eng:
Address:
Phone:
Zip:
Phone: NONEAVAILABLE
COSTA MESA Zip: 92626
Phone:
Zip:
License:
Phone:
Zip:
License:
SCOPE OF PERMIT
REPAIR DAMAGED SEWER LINE. 1 SEWER CONNECTION.
PE
P98-00795 J
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 10/26/1998
Issued: 102611998
AMT QTY
Sump Pump
$0.00
0
FEESUMMARY
$0.00
0
AMT
QTY
0
AMT
pry
ISSUE FEE
$22.00
$0.00
Laundry Tub/Washer
$0.00
0
Backflow Imgation
$0.00
0
Landscape Irrigation
$0.00
0
Backflow Preventer
$0.00
0
P -Trap
$0.00
0
Bathtub
$0.00
0
Pressure Regulator
$0.00
0
Clarifier System
$0.00
0
Process Piping (per 10 ft)
$0.00
0
Conned(Ice,Soda,etc)
$0.00
0
Receptors
$0.00
0
Dental Units
$0.00
0
Septic Tank
$0.00
0
Dishwasher
$0.00
0
Sewer Cap for Demo
50.00
0
Drain, Floor
$0.00
0
Sewer Connect
$22.00
1
Drain, Rainwater
$0.00
0
Sewer Private Line
$0.00
0
Drain, Roof
$0.00
0
Shower
$000
0
Drinking Fountain
$0.00
0
Sink, bar
$0.D0
0
Expansion Tank
$0.00
0
Sink, commercial
$0.00
0
Gas Earthquake Valve
$0.00
0
Sink, Floor
$0.00
0
Gas (14 outlets)
$0.00
0
Sink, kitchen
$0.00
0
Gas (Over 4 outlets)
$0.00
0
Sink, service/mop
$0.00
0
Gas Repipe
$0.00
0
Spa (private)
$0.00
0
Gas Service
$0.00
0
Spa (public)
$0.00
0
PE
P98-00795 J
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 10/26/1998
Issued: 102611998
AMT QTY
Sump Pump
$0.00
0
Swimming Pool
$0.00
0
Trap Primer
$0.00
0
Urinal
$0.00
0
Vacuum Bdcr Bkflow(l-0)
$0.00
0
Vacuum Brkr Bkflow(5i)
$0.00
0
Wash Basin
$0.00
0
Wash Basin Set
$0.00
0
Waste and Vent System
$0.00
0
Water Closet (Toilet)
$0.00
0
Water Healer/vent
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Water Re -pipe
$0.00
0
Water Service
$0.00
0
Water Softener
$0.00
0
OTHER
$0.00
VIOLATION
$0.00
PLAN CHECK
$0.00