HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 22-00080 - 1053 Cypress Loop - 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
Legacy Electric
Nick 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
nickleishman@gmail.com 208-716-0420
Electrical 35219 5/31/2022 $
Permit Information
Please enter in the following format: 00-00000
22-00080 1053 Cypress Loop New SFR
1053 Cypress Loop
Acceptance
Sign 3/7/2022