HomeMy WebLinkAbout19-00154 Contractor Info Form GL Edwards Electric.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
GL Edwards Electric
LeRoy Edwards
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
1132 Crescent Dr
Address Line 2
gledwardselectric@gmail.com 2084039614
Electrical ELE-C-27774 4/4/2020 12,715.00$
Permit Information
Please enter in the following format: 00-00000
19-00154 Walmart Grocery Pickup Addition
1450 N 2nd E, Rexburg, ID 83440
Acceptance
Sign 6/26/2019