HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 22-00237 - 32 S 2nd E - Karie AnnesContractor 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 ElE-C-35219 6/30/2022 1,500.00$
Permit Information
Please enter in the following format: 00-00000
22-00217 Carrie Anns
Main Street
Acceptance
Sign 4/5/2022