HomeMy WebLinkAboutWORK ACCEPTANCE FORM COOPER CANYON ELECTRIC - 21-00789 - Rocky Mountain Power - Mechanic ShopContractor 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
Copper canyon electric
Andrew Chase
City
Rigby
State / Province / Region
Idaho
Postal / Zip Code
83442
Country
Jefferson
Update new contact information that is not already on file with the City of Rexburg
Street Address
4093 e 370 n
Address Line 2
coppercanyonelectric@yahoo.com 2087092387
2087092387
Electrical 038628 3/31/2023 110,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00789 Rocky Mountian power
170 w 2nd n Rexburg Idaho 83440
Acceptance
Sign 8/10/2022