HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELECTRICAL SUPPORT SERVICES - 19-00401 - Pizza Hut - Tenant 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
Electrical support services
Brent Purcell
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
brentjp@msn.com 208-251-6022
Electrical C-4342 11/30/2020 25,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00401 Pizza Hut 2175
136 W Main St Rexburg, ID 83440
Acceptance
Sign 11/18/2019