HomeMy WebLinkAboutWORK ACCEPTANCE FORM MOUNTAIN WEST ELECTRIC - 19-00257 - 293 E 7th N - Well House Building #8Contractor 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
Mountain West Electric, Inc.
Dana Brown
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
586 W. Highway 26 #1
Address Line 2
dbrown@mtnwestelec.com 2086845463
Electrical ELE-C-3802 12/31/2020 450,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00257 Rexburg Well House #9
293 E. 7th N.
Acceptance
Sign 1/3/2020