HomeMy WebLinkAboutWORK ACCEPTANCE FORM SYNERGY ELECTRIC - 20-00413 - 425 Harvard Ave - Blake Willis - Duplex Bldg 3Contractor 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
SYNERGY ELECTRIC SOLUTIONS, INC.
Nate Gallup
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
1 Landmark Lane
Address Line 2
Suite 1
AMYJ@SESID.US 208.228.5535
208.390.9553
Electrical 018980 6/30/2022 15,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00169 Blake Willis Duplex
425 Harvard Ave 1001, 1101
Acceptance
Sign 6/17/2021