HomeMy WebLinkAboutWORK ACCEPTANCE FORM GRIZZLY ELECTRIC - 21-00669 - 1080 Cypress Loop - 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
Grizzly Electric
Quinten Bair
City
Rigby
State / Province / Region
33943061
Postal / Zip Code
83442
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
142 N 4400 E
Address Line 2
grizzlyelectric@live.com 12085205225
Electrical ele-c-31836 1/31/2022 12,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00669 Kevin Larsen
Pine Brook Div 2 Lot 9 Block 3
Acceptance
Sign 9/2/2021