HomeMy WebLinkAbout19-00349 Contractor Info Form Mountain West Electric, Inc..pdfContractor 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
Mountain West Electric, Inc.
Greg Scott
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
586 West Highway 26, #1
Address Line 2
dbrown@mtnwestelec.com 208.684.5463
208.705.0577
Electrical ELE-C-3802 12/31/2019 1,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00349 Taco Bell kiosk installation
22 West Main St., Rexburg, ID 83440
Acceptance
Sign 6/11/2019