HomeMy WebLinkAboutWORK ACCEPTANCE FORM PACKER ELECTRIC - 21-00559 - Cooper Norman - Commercial RemodelContractor 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
Packer Electric
Monte Packer
City
Idaho Falls
State / Province / Region
ID
Postal / Zip Code
83401
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
4107 E 49 N
Address Line 2
packerelectric1@gmail.com 2085897011
208 589-7011
Electrical ELE-C-2116 7/31/2022 40,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00559 Cooper Norman Commercial Remodel
859 Yellowstone Highway
Acceptance
Sign 8/9/2021