HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLANE ROBBINS ELECTRICAL INC - 20-00112 - 40 N 4th E - Cable One PedestalContractor 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
Blane Robbins Electric, Inc.
Kennidee Robbins
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
431 W. 100 N
Address Line 2
sbsrobbins@aol.com 208-680-3826
208-709-6334
Electrical ELE-C-12881 12/31/2020 510.00$
Permit Information
Please enter in the following format: 00-00000
20-00112 40 N 4th E Cable One Pedestal
402 Reed St
Acceptance
Sign 3/2/2020