HomeMy WebLinkAboutWORK ACCEPTANCE FORM NELSON ELECTRIC - 21-00305 - BYUI Ricks Building - Chiller & Ice Bank UpgradeContractor 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
Nelson Electric, LLC
Karren Nelson
City
Menan
State / Province / Region
ID
Postal / Zip Code
83434
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
PO Box 142
Address Line 2
karren@nelson-electricllc.com 2087549389
Electrical ELE-C-38127 11/30/2021 13,320.00$
Permit Information
Please enter in the following format: 00-00000
21-00305 BYU-Idaho RKS Chiller & Ice Bank
BYU-Idaho Campus
Acceptance
Sign 5/13/2021