HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEISHMAN ELECTRIC - 19-00378 - 352 E 5th S - Garage 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
Leishman Electric
Todd Leishman
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
442 S 4th E
Address Line 2
leishmanelectric@yahoo.com 2083564796
2083905066
Electrical C-1934 4/30/2020 6,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00378 Kent Jackson
352 E. 5th S. Rexburg, ID 83440
Acceptance
Sign 1/21/2020