HomeMy WebLinkAboutWORK ACCEPTANCE FORM GL EDWARDS ELECTRIC - 22-00274 - 333 Shoshone Ave - Bathroom 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
GL Edwards Electric
LeRoy Edwards
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
gledwardselectric@gmail.com 208-403-9614
Electrical ELE-C-27774 3/31/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00274 333 Shoshone Ave - Bathroom Remodel
333 Shoshone Ave
Acceptance
Sign 4/19/2022