HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELECTRICAL SUPPORT SERVICES - 09-00243 - The Raspberry Garden Apartments - 3 UnitsContractor 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
Electrical support services
Brent purcell
City
Shelley
State / Province / Region
Idaho
Postal / Zip Code
83274
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
1037 E. 1400 N.
Address Line 2
brentjp@msn.com 2082516022
Electrical Ele-c-4342 8/31/2022 800.00$
Permit Information
Please enter in the following format: 00-00000
09-00243 Raspberry gardens
177 s 4th west
Acceptance
Sign 8/10/2021