HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 20-00297 - 460 S 4th E - SFR 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
Legacy electric
Ryan Leishman
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83330
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
4455 Jud Street
Address Line 2
ryanleishman@gmail.com 2083903306
Electrical 35219 7/7/2021 $
Permit Information
Please enter in the following format: 00-00000
20-00297 Kent hayes
460south 4east Rexburg idaho
Acceptance
Sign 7/7/2020