HomeMy WebLinkAboutWORK ACCEPTANCE FORM COPPER CANYON ELECTRIC - 21-00160 - 1354 Clover Ct - 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
boneville
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 9,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00160 rx-01354
1354 clover Ct rexburg
Acceptance
Sign 4/27/2021