HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLUNCK ELECTRIC - 21-00709 - Clair & Dees Point S Tires - RemodelContractor 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
Blunck Electric Inc
Gerald Blunck
City
REXBURG
State / Province / Region
IDAHO
Postal / Zip Code
83440
Country
MADISON
Update new contact information that is not already on file with the City of Rexburg
Street Address
47 Mill Race Rd
Address Line 2
blunckelectric@gmail.com 2087095687
Electrical ele-c-1914 2/28/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00709 Advance Point S
103 N 2nd E
Acceptance
Sign 1/3/2022