HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLANE ROBBINS ELECTRIC - 20-00356 - 1106 Greenside Loop - Bryant 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
Blane Robbins Electric
Blane Robbins
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
431 W 100 N
Address Line 2
sbsrobbins@aol.com 2087854674
Electrical ELE-C-12881 12/31/2021 $
Permit Information
Please enter in the following format: 00-00000
20-00356 1106 Greenside Loop
1106 Greenside Loop
Acceptance
Sign 2/12/2021