HomeMy WebLinkAboutWORK ACCPETANCE FORM ORANGE ELECTRIC - 19-00498 - 517 W Main - Egress WindowsContractor 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
Orange Electric LLC
Jean-Michel Knickerbocker
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
587 REAGAN AVE
Address Line 2
Orangeelectric.knick@gmail.com 2087409501
Electrical 024083 1/31/2020 1,500.00$
Permit Information
Please enter in the following format: 00-00000
19-00498 Eric rose
517 w main Rexburg Idaho 83440
Acceptance
Sign 9/4/2019