HomeMy WebLinkAboutWORK ACCEPTANCE FORM EAST IDAHO ELECTRIC - 21-00780 - 111 E 2nd N - Units 1 & 2 - Duplex ConversionContractor 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
East Idaho Electric
Steven N Thompson
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
122 S 1075 W
Address Line 2
snthompson@cableone.net 2088400798
2088400798
Electrical ele-c-19998 3/31/2022 6,200.00$
Permit Information
Please enter in the following format: 00-00000
20-00780 Doug Anderson
111 E 2nd N; Rexburg, Idaho
Acceptance
Sign 11/8/2021