HomeMy WebLinkAboutWORK ACCEPTANCE FORM VIRGIN ELECTRIC - 20-00239 - Porters Building - RemodelContractor 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
Virgin electric
Jerry Virgin
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
Madison
Update new contact information that is not already on file with the City of Rexburg
Street Address
111 north center
Address Line 2
jerryg.virgin@gmail.com 2083511970
Electrical ELE-C-777 8/31/2020 $
Permit Information
Please enter in the following format: 00-00000
20-00239 Chuck porter
19 college avenue
Acceptance
Sign 4/23/2020