HomeMy WebLinkAboutWORK ACCEPTANCE FORM XTREME ELECTRIC - 21-00537 - Caliber Smart Gym - 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
Xtreme Electric
Blake Larsen
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
xtreme3003@gmail.com 208-313-3003
Electrical ele-c-27283 10/31/2021 7,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00537 Caliber Smart Gym - Remodel
1160 Bond Ave
Acceptance
Sign 9/2/2021