HomeMy WebLinkAboutWORK ACCEPTANCE FORM PRO ELECTRIC - 20-00248 - Vista Medical OfficeContractor 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
Pro
Caleb Wheeler
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
204 N. 205 W
Address Line 2
proelectric1@msn.com 2086047500
Electrical ELE-C-33214 11/30/2020 44,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00251 Pro Electric Inc.
204 N. 205 W
Acceptance
Sign 6/8/2020