HomeMy WebLinkAboutWORK ACCEPTANCE FORM D&D ELECTRIC - 21-00665 - 128 N 4th W - Mobile Home to real propertyContractor 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
D & D Electric
Paul Weekes
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
weekesp@gmail.com 208-313-2976
Electrical ELE-C-23756 7/1/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00665 Mobile home
128 N 4th W
Acceptance
Sign 11/8/2021