HomeMy WebLinkAboutWORK ACCEPTANCE FORM VIRGIN ELECTRIC - 17-00304 - 342 S 4th E - DuplexContractor 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
Virgin Electric
Jerry Virgin
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
jerrygvirgin@gmail.com 208-351-1970
Electrical ELE-C-777 8/31/2020 $
Permit Information
Please enter in the following format: 00-00000
17-00304 Duplex
342 S 4th E
Acceptance
Sign 11/13/2019