HomeMy WebLinkAboutWORK ACCEPTANCE FORM BRAD HORSELY ELECTRIC - 20-00314 - Advance Auto Parts - 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
Brad Horsley Electric
Brad Horsley
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
222 E 325 N
Address Line 2
horsleyelectric@yahoo.com 208-785-3451
Electrical ELE-C-3796 11/30/2020 56,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00314 Advanced Auto Parts
125 Valley River Dr, 309
Acceptance
Sign 9/28/2020