HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 22-00263 - 7N Apartments - Bldg 4 - 4 PlexContractor 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
Ryan 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
ryanleishman@msn.com (208)390-3306
Electrical ELE-C-35219 6/30/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00260 7N Apartments
676 Carlow Dr Units 1101-1102, 1201-1202
Acceptance
Sign 7/8/2022