HomeMy WebLinkAboutWORK ACCEPTANCE FORM WIRED ELECTRICAL SERVICES LLC - 21-00670 - 1141 John Hancock - 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
Wired Electrical Services, LLC
Justin Seymour
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
1141 John Hancock Ave
Address Line 2
kalvinkoetting@gmail.com 2085097900
Electrical 046912 5/31/2022 12,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00670 Justin Seymour
1141 John Hancock Ave.
Acceptance
Sign 4/25/2022