HomeMy WebLinkAboutWORK ACCEPTANCE FORM S&S ELECTRIC - 19-00587 - 160 W 2nd St Ste 102 - Crumbl CookiesContractor 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
S&S ELECTRIC
Derik Sutton
City
Ririe
State / Province / Region
ID
Postal / Zip Code
83443
Country
Usa
Update new contact information that is not already on file with the City of Rexburg
Street Address
P.O. Box 433
Address Line 2
dsutton@sandselec.com 2083907877
Electrical 023524 7/31/2020 33,600.00$
Permit Information
Please enter in the following format: 00-00000
19-00587 Crumbl cookie
160 west 2nd street suite 102
Acceptance
Sign 11/4/2019