HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEISHMAN ELECTRIC - 22-00474 - Transfer Station - New Scale HouseContractor 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
Bron Leishman
City
Rexburg
State / Province / Region
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 E
Address Line 2
leishmanelectric@yahoo.com 208-356-3770
Electrical C-1934 4/30/2023 28,000.00$
Permit Information
Please enter in the following format: 00-00000
22-00474 Transfer Station/ Scale House
529 Airport Rd
Acceptance
Sign 12/6/2022