HomeMy WebLinkAboutWORK ACCEPTANCE FORM NELSON ELECTRIC - 20-00648 - Valley Ag Fertilizer Plant - AdditionContractor 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
Nelson Electric
Greg Nelson
City
RIGBY
State / Province / Region
ID
Postal / Zip Code
83442
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
3896 East 600 North
Address Line 2
greg@nelson-electricllc.com 2087548939
2083903424
Electrical 38127 11/30/2020 $
Permit Information
Please enter in the following format: 00-00000
20-00648 Valley Wide Fertilizer Plant
Rexburg
Acceptance
Sign 9/2/2020