HomeMy WebLinkAboutWORK ACCEPTANCE FORM TWO WIRE ELECTRIC - 19-00604 - America First Credit Union - RemodelContractor 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
Two Wire Electric LLC
Ryan Rackham
City
West Point
State / Province / Region
UT
Postal / Zip Code
84015
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
4475 West 25 South
Address Line 2
ryan@twowireelectric.net 801-721-5952
801-721-5952
Electrical RCE-52569 10/13/2020 73,954.00$
Permit Information
Please enter in the following format: 00-00000
19-00604 America First Credit Union
510 North 2nd East Suite 3 Rexburg ID
Acceptance
Sign 10/13/2020