HomeMy WebLinkAboutWORK ACCEPTANCE FORM RUSSELL ELECTRIC - 19-00216 - Centennial Townhomes - Bldg 1-C - 4 PlexContractor 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
RUSSELL ELECTRIC
DOUG RUSSELL
City
IDAHO FALLS
State / Province / Region
ID
Postal / Zip Code
83401
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
2239 E TIMBERVIEW DR
Address Line 2
russellelectricpower@gmail.com 2087097458
Electrical ELE-C-33253 4/30/2020 $
Permit Information
Please enter in the following format: 00-00000
19-00216 CENTENNIAL TOWNHOMES
CENTENNIAL
Acceptance
Sign 6/14/2019