HomeMy WebLinkAboutWORK ACCEPTANCE FORM PLATINUM ELECTRIC - 21-00331 - 201 S Millhollow Rd - 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
Platinum Electric
Spencer Pena
City
Rigby
State / Province / Region
Idaho
Postal / Zip Code
83442
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
235 Ramona Ave.
Address Line 2
2spena2@gmail.com 208-403-3040
Electrical 038799 3/31/2021 $
Permit Information
Please enter in the following format: 00-00000
21-00331 Benfield home
201 S. millhollow Rd
Acceptance
Sign 6/1/2021