HomeMy WebLinkAboutWORK ACCEPTANCE FORM COPPER CANYON ELECTRIC - 21-00013 - 1362 Clover Court - 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
Copper canyon electric
Andrew chase
City
Iona
State / Province / Region
Idaho
Postal / Zip Code
83427
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
3142 Quakey aspen drive
Address Line 2
coppercanyonelectric@yahoo.com 2087092387
2087092387
Electrical 038628 3/31/2022 14,157.00$
Permit Information
Please enter in the following format: 00-00000
21-00013 Fitgeald
1362 Clover Ct
Acceptance
Sign 1/27/2021