HomeMy WebLinkAboutWORK ACCEPTANCE FORM NORTHERN LIGHTS ELECTRIC - 19-00718 - 1137 Summers Dr - Valleywide Coop/Forsgren - Commercial BuildingContractor 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
Northern lights electric LLC
Rod Sorenson
City
IDAHO FALLS
State / Province / Region
ID
Postal / Zip Code
83401
Country
Usa
Update new contact information that is not already on file with the City of Rexburg
Street Address
3473 E 20TH N UNIT A
Address Line 2
nlerod@live.com 2087579473
Electrical Ele-c-33497 4/30/2021 35,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00718 Forsgren engineering
1137 summers drive
Acceptance
Sign 4/24/2020