HomeMy WebLinkAboutWORK ACCPETANCE FORM JW ELECTRIC - 19-00503 - Andreason - 1120 Greenside Loop - New SFRContractor 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
J W Electrci LLC
Jared Wilde
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
wildej20@gmail.com 208-313-2058
Electrical 013805 9/30/2019 $
Permit Information
Please enter in the following format: 00-00000
19-00503 Andreasen Residence
Andreasen home in pinebrook subdivision
Acceptance
Sign 9/5/2019