HomeMy WebLinkAboutWORK ACCEPTANC EFORM MOUNTAIN VALLEY ELECTRIC - 21-00119 - Adams Elementary School - 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
Mountain Valley Electric
Zach Giles
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
3880 E 200 N
Address Line 2
zach@mountainvalleyelectric.com 2082280775
2083907163
Electrical 021047 10/31/2021 171,115.00$
Permit Information
Please enter in the following format: 00-00000
21-00119 Adams Elementary 2021 additions
110 North 2nd East
Acceptance
Sign 4/28/2021