HomeMy WebLinkAboutWORK ACCEPTANCE FORM MICKELSEN ELECTRIC - 22-00356 - 126 Charles Place - 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
Mickelsen Electric
Marcus Mickelsen
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
mickelsenelectric@gmail.com 208-681-1830
Electrical 041976 7/31/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00356 Nola Harris
Charles Place
Acceptance
Sign 12/29/2022