HomeMy WebLinkAboutWORK ACCEPTANCE FORM RONN ALLEN ELECTRIC - 22-00034 - Nitro Car WashContractor 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
Ronn Allen Electric
Mike Jensen
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
mike.raelectric@yahoo.com 208-520-9421
Electrical Ele-C-31018 5/31/2022 $
Permit Information
Please enter in the following format: 00-00000
22-00034 Nitro Car Wash
1371n N 2nd E
Acceptance
Sign 1/24/2022