HomeMy WebLinkAboutWORK ACCEPTANCE FORM MOUNTAIN WEST ELECTRIC - 23-00022 - BYUI Hart - Physical Treatments Center RemodelContractor 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
Mountain West Electric, Inc.
Chad Fields
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
586 West Highway 26 Box #1
Address Line 2
coordinator@mtnwestelec.com 2086845463
Electrical ELE-C-3802 12/31/2023 98,470.00$
Permit Information
Please enter in the following format: 00-00000
23-00022 BYU-I Hart ASI 08
311 S. 1st W.
Acceptance
Sign 1/31/2023