HomeMy WebLinkAboutWORK ACCEPTANCE FORM SYNERGY ELECTRIC - 19-00749 - 722 S 2470 W - Summerfield ClubhouseContractor 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
SYNERGY ELECTRIC SOLUTIONS, INC.
NATHAN GALLUP
City
RIGBY
State / Province / Region
ID
Postal / Zip Code
83442
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
3943 E 200 N
Address Line 2
NATEG@SESID.US 208.228.5535
208.228.5535
Electrical 018980 6/30/2020 100,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00749 SUMMERFIELD CLUB HOUSE
3000 W 850 S RREXBURG, ID 83440
Acceptance
Sign 4/9/2020