HomeMy WebLinkAboutWORK ACCEPTANCE FORM SYNERGY ELECTRIC - 20-00557 - 1012 Cypress Loop - Price 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
Synergy Electric Solutions, Inc.
Nathan Gallup
City
Rigby
State / Province / Region
ID
Postal / Zip Code
83442
Country
US
Update new contact information that is not already on file with the City of Rexburg
Street Address
3943 E 200 N
Address Line 2
AMYJ@SESID.US 2082285535
208.390.9553
Electrical 018980 7/1/2021 12,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00557 Fillmore Project
lot 25 blk 4 Pinebrook Estates
Acceptance
Sign 7/15/2020