HomeMy WebLinkAboutWORK ACCEPTANCE FORM SUPERIOR ELECTRIC SERVICE - 22-00003 1203 Castle Pines Rd - New SFRContractor 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
Superior Electric Service
Jeffrey Wayment
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
2328 W 960 S
Address Line 2
jeffw@superiorelectricservicellc.com 2083204329
Electrical 049801 10/31/2022 29,500.00$
Permit Information
Please enter in the following format: 00-00000
22-00003 Belmont House
1203 Castle Pines Rd
Acceptance
Sign 2/17/2022