HomeMy WebLinkAboutWORK ACCEPTANCE FORM VELOCITY MARK ELECTRIC - 20-00211 - Dayton - 1092 Cypress Loop - New SFRContractor 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
Velocity Mark Electric
Destry Orr
City
Saint Anthony
State / Province / Region
Idaho
Postal / Zip Code
83445
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
406 West 2nd North
Address Line 2
velocitymarkco@gmail.com 208-221-4801
Electrical 032389 1/31/2021 $
Permit Information
Please enter in the following format: 00-00000
20-00211 Dayton
1092 Cypress Loop
Acceptance
Sign 6/21/2020