HomeMy WebLinkAboutAPPLICATION & RECEIPT - 16-00072 - 30 Carlson Ave - Cure Touch - OutletsSubmission Date 2016-02-11 13:01:51
Owner's Name Bernie Jensen
Property Address Street Address: 30 Carlson Ave
City: Rexburg
State / Province: Idaho
Postal / Zip Code: 83440
Country: United States
Are you the Homeowner and
doing the work yourself?
No
Electrical Contractor's Name Scott Larsen
Business Name High Mountain Electric
Address Street Address: 4345 Jud St.
City: Rexburg
State / Province: Idaho
Postal / Zip Code: 83440
Country: United States
Primary Phone ((208)) 356-0307
Primary Phone Type Home Phone
Secondary Phone (208) 317-3856
Secondary Phone Type Cell Phone
E-mail highmtelectric@gmail.com
Type of Construction Commercial Remodel
Please Describe the Type of
Work to Be Done
electrical outlets, switches, lights
Are you replacing everything
like for like?
No
Signature of Licensed
Contractor
not contractor
License number and Exp.
Date
unknown
Date 02-11-2016
Electrical Application
Transaction detail for payment to City of Rexburg. Date: 02/11/2016 - 1:22:09 PM
Billing Information
High Mountain Electric High
Mountain Electric
, 83440
highmtelectric@gmail.com
City of Rexburg
35 N 1st East | PO Box 280
Rexburg, ID 83440
208-359-3020
ub@rexburg.org
XBP Confirmation Number: 14942025
Transaction Number: 47508975PT
Visa — XXXX-XXXX-XXXX-3363
Status: Successful
Account # Item Quantity Item Amount
16-00072 Electrical Permit 1 $80.00
Notes: Permit # 16-00072
TOTAL:$80.00
Transaction taken by: porterw
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1 of 1 2/11/2016 1:22 PM