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CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS COELECTRICAL UTILITY REL&E FORM
TRACT
LOT
ADDRESS
GAS
ELEC.
UN.
NO. METER
OUTLETS
NO. METERS
RELEASED
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ItJ.NEW CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAIN)
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CMF 077146
CITY OF COSTA MESA
BUILDING SAFETY DIVISION
GAS OR ELECTRICAL UTILITY RELEASE FORM
TRACT
LOT
ADDRESS
OAS
ELEC.
NO.
UNITS
NO.METER
OUTLETS
NO.METERS
RELEASED
THESE INSPECTIONS AREA RESULT OF: (CHECKUNtl
\4MEW CONSTRUCTION E3 REWIRING ❑ OTHER (EXPLAIN)
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CMF 077246
7 CITY OF COSTA MESA
BUILDING SAFETY DIVISION -
GAS OR ELECTRICAL UTILITY RELEASE FORM
THESE INSPECTIONS AREA RESULT OF: (CHECKONE)
�4!W CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAINI
Date Released
CMF 077246
NO.
NO.METER
NO. METERS
TRACT
LOT
ADDRESS
GAS
ELEC.
UNITS
OUTLETS
RELEASED
L
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THESE INSPECTIONS AREA RESULT OF: (CHECKONE)
�4!W CONSTRUCTION ❑ REWIRING ❑ OTHER (EXPLAINI
Date Released
CMF 077246
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