HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 21-00617 - Crispy Cone - 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
Legacy Electric Inc
Ryan Leishman
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
ryanleishman@msn.com 208-390-3306
Electrical ELE-C-35219 6/30/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00837 Crispy Cone
163 W Main St - Suite 102
Acceptance
Sign 2/16/2022