HomeMy WebLinkAboutWORK ACCEPTANCE FORM HIGH MOUNTAIN ELECTRIC CO - 19-00359 - 871 Jet Stream Dr - The Rock Gym - New CommercialContractor 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
High Mountain Electric Co
Scott Larsen
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
651 east 3000 North
Address Line 2
highmtnelectric@gmail.com 208-317-3856
Electrical 27592 1/31/2022 180,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00359 Rock wall
869 Jetstream Dr Rexburg 83440
Acceptance
Sign 6/26/2019