HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEISHMAN ELECTRIC - 19-00499 - 111 W 7th S - BYUI University Apartments ClubhouseContractor 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
Leishman Electric
Tyson Leishman
City
Rexburg
State / Province / Region
Id
Postal / Zip Code
83440
Country
Usa
Update new contact information that is not already on file with the City of Rexburg
Street Address
442 south. 4th east
Address Line 2
leishmanelectric@yahoo.com 2087093107
Electrical C-1934 4/30/2020 300,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00499 Tyson Leishman
111 w 7th south
Acceptance
Sign 10/9/2019