HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 17-00479 - Cantamere - Bldg 18 (21) - 4 PlexContractor 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
legacy Electric
Ryan leishman
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
4455 Jud Street
Address Line 2
ryanleishman@gmail.com 2083139379
Electrical 35219 7/29/2021 14,800.00$
Permit Information
Please enter in the following format: 00-00000
17-00479 Cantemere apartments
591 Turin way
Acceptance
Sign 7/29/2020