HomeMy WebLinkAboutWORK ACCEPTANCE FORM MOUNTAIN VALLEY ELECTRIC - 19-00224 - 111 W Main St - Graffiti Hair Salon - New WiringContractor Work Acceptance Form
Business Name:*
Contact Name:*
Mailing Address
Email:*Phone:*
Mobile:
Discipline:*License #:*Expiration Date:*Value of Work:
Permit Number:*
Project Name:*
Project Address:*
By signing, I acknowle dge that I am the indicate d contractor for the abov e me ntione d Pe rmit/Proje ct.
Signature Date
Contractor/Subcontractor
Giles Electric, LLC dba Mountain Valley Electric
Zach Giles
City
Rigby
State / Province / Region
ID
Postal / Zip Code
83442
Country
US
Update new contact information that is not already on file with the City of Rexburg
Street Address
458 N 4000 E 3
Address Line 2
zach@mountainvalleyelectric.com 2082280775
2083907163
Electrical 021047 10/31/2019 $
Permit Information
Please enter in the following format: 00-00000
19-00224 Graffiti Hair Salon - New Wiring
111 W Main St
Acceptance
Sign 4/25/2019