HomeMy WebLinkAboutWORK ACCEPTANCE FORM BRIGGS ELECTRICAL - 22-00059 - Jave EspressContractor 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
Briggs Electrical
Michael Briggs
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
mbriggs1979@gmail.com 208-312-2667
Electrical ELE-C-25536 9/30/2023 48,000.00$
Permit Information
Please enter in the following format: 00-00000
22-00059 Java Express
565 N 2nd E
Acceptance
Sign 2/23/2023