HomeMy WebLinkAboutWORK ACCEPTANCE FORM BEAR RIVER ELECTRIC - 20-00808 -OPTIS - 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
Bear River Electric, LLC
Forrest Lusk
City
Soda Springs
State / Province / Region
Idaho
Postal / Zip Code
83276
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
591 West Highway 30
Address Line 2
fluskbre@gmail.com 208-251-3484
Electrical ele-c-36615 2/28/2022 17,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00808 Optix
142 W 1st N
Acceptance
Sign 1/28/2021