HomeMy WebLinkAboutWORK ACCEPTANCE FORM HIGH MOUNTAIN ELECTRIC - 19-00686 - 1110 Golden Beauty Dr - Wilcox AdditionContractor 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
High Mountain Electric Co.
Scott Larsen
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
651 E 3000 N
Address Line 2
highmtnelectric@gmail.com 208-317-3856
Electrical ELE-C-27592 1/31/2020 3,756.00$
Permit Information
Please enter in the following format: 00-00000
19-00686 Wilcox Fresh
1110 Golden Beauty Dr.
Acceptance
Sign 1/6/2020