HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEISHMAN ELECTRIC - 22-00063 - 744 Hillside Dr - 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
Todd Leishman
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
442 S 4th eE
Address Line 2
leishmanelectric@yahoo.com 208-356-3770
208-390-5066
Electrical C-1934 4/30/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00063 John Hegsted
744 Hillside Dr
Acceptance
Sign 7/14/2022