HomeMy WebLinkAboutWORK ACCEPTANCE FORM NELSON ELECTRIC, LLC - 22-00795 - Madison Station ApartmentsContractor 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
Nelson Electric, LLC of Idaho
Sean Cook
City
Menan
State / Province / Region
ID - Idaho
Postal / Zip Code
83434
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
PO Box 142
Address Line 2
sean@nelson-electricllc.com 2087549389
Electrical ELE-c-38127 11/30/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00795 Madison Station
579 Trejo Street, Rexburg
Acceptance
Sign 4/5/2023