HomeMy WebLinkAboutWORK ACCEPTANCE FORM COPPER CANYON ELECTRIC - 20-00599 - 1299 Stone Dr - 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
834247
Country
Bonneville
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
20-00599 Rx -01299
1299 Stone drive Rexburg
Acceptance
Sign 4/27/2021