HomeMy WebLinkAboutWORK ACCEPTANCE FOMR BRAD HORSLEY ELECTRIC - 21-00586 - Just4Kids Pediatric Urgent CareContractor 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 acknowledge that I am the indicated contractor for the above mentioned Permit/Project.
Signature Date
Contractor/Subcontractor
Brad Horsley Electric
Brad Horsley
City
Blackfoot
State / Province / Region
Idaho
Postal / Zip Code
83221
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
222 E 325 N
Address Line 2
horsleyelectric@yahoo.com 208 785 3451
208 681 7362
Electrical ele-C-3796 11/30/2021 150,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00586 just 4 kids
1218 Bond Avenue
Acceptance
Sign 9/21/2021