HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEISHMAN ELECTRIC - 22-00151 - 1011 Pine Brook Ln - 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
Leishman Electric
Tyson Leishman
City
REXBURG
State / Province / Region
ID
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
442 S 4th E
Address Line 2
leishmanelectric@yahoo.com 2087093107
Electrical C1934 4/30/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00151 Jerry Merrill
1011 Pinebrook Lane
Acceptance
Sign 6/27/2022