HomeMy WebLinkAboutWORK ACCEPTANCE FORM MICKELSEN ELECTRIC LLC - 22-00218 - 155 & 171 Charles Place - New SFR - Twin HomeContractor 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
MICKELSEN ELECTRIC LLC
Marcus Mickelsen
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
594 wooten way
Address Line 2
mickelsenelectric@gmail.com 2086811830
Electrical 041976 7/31/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00218 CHARLES PLACE
177 AND 155 CHARLES PLACE REXBURG
Acceptance
Sign 10/18/2022