HomeMy WebLinkAboutWORK ACCEPTANCE FORM COPPER CANYON ELECTRIC - 21-00628 - 1105 Larch Dr - New SFRContractor 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
Copper Canyon Electric
Andrew Chase
City
rigby
State / Province / Region
idaho
Postal / Zip Code
83442
Country
United states
Update new contact information that is not already on file with the City of Rexburg
Street Address
4093 e 370 n
Address Line 2
Coppercanyonelectric@yahoo.com 208-709-2387
208-709-2387
Electrical 038628 6/30/2024 11,150.00$
Permit Information
Please enter in the following format: 00-00000
21-00628 Blue Thistle Homes
1105 Larch drive Rexburg
Acceptance
Sign 8/25/2021