HomeMy WebLinkAboutWORK ACCEPTANCE FORM ORANGE ELECTRIC - 21-00624 - Key Bank - 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
Orange Electric
Jean-Michel knickerbocker
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
orangeelectric.knick@gmail.com 208-740-9501
Electrical 024083 1/31/2022 3,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00624 Key Bank - Remodel
110 E Main St
Acceptance
Sign 8/20/2021