HomeMy WebLinkAboutWORK ACCEPTANCE FORM HOTWIRE ELECTRIC - 19-00165 - 651 W Main St - Block Building - DuplexContractor 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
Hotwire Electric
Blaise Kauer
City
Ammon
State / Province / Region
ID.
Postal / Zip Code
83406
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
3270 East 17th #234
Address Line 2
hotwireelectricllc@gmail.com 2086041871
2086041871
Electrical ele-c-34487 12/31/2019 7,800.00$
Permit Information
Please enter in the following format: 00-00000
19-00165 Marshall ricks
Main street
Acceptance
Sign 5/10/2019