HomeMy WebLinkAboutWORK ACCEPTANCE FORM LARSEN ELECTRIC - 19-00727 - Spori Annex - Ceramic & Sculpture LabsContractor 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
Larsen Electric LLC
Darren Larsen
City
Pocatello
State / Province / Region
ID
Postal / Zip Code
83206
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
PO Box 2871
Address Line 2
darren@larsenelectric.net 208-237-2058
208-221-4452
Electrical ELE-C-27173 10/31/2020 403,745.00$
Permit Information
Please enter in the following format: 00-00000
19-00727 BYU Idaho Spori Annex
525 S Center Street
Acceptance
Sign 3/5/2020