HomeMy WebLinkAboutWORK ACCEPTANCE FORM NELSON ELECTRIC - 22-00736 - Madison High School - Broadcast BoothContractor 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
Nelson Electric
Greg Nelson
City
Menan
State / Province / Region
Idaho
Postal / Zip Code
83434
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
PO Box 142
Address Line 2
greg@nelson-electricllc.com 2087549389
Electrical PWC-C-17421-unlimited-4 5/31/2023 59,122.09$
Permit Information
Please enter in the following format: 00-00000
22-00736 Madison Baseball Broadcast Booth
2300 University Blvd Rexburg, ID 83440
Acceptance
Sign 10/10/2022