HomeMy WebLinkAboutWORK ACCEPTANCE FORM EMPIRE SOLAR GOUP - 19-00416 - 980 Westwood Dr - Solar PanelsContractor 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
Empire Solar Group
Ashleigh Egbert
City
Salt Lake City
State / Province / Region
Utah
Postal / Zip Code
84111
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
9 Exchange Pl, Ste 400
Address Line 2
permits@empiresolargroup.com 385-415-9655 x1030
Electrical 026803 7/31/2019 4,116.00$
Permit Information
Please enter in the following format: 00-00000
19-00416 Gaylen Jensen
980 Westwood Dr, Rexburg, ID 83440
Acceptance
Sign 7/23/2019