HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELECTRICAL OWNER BUILT - 23-00354 - 3704 Henry's Fork Way - New SFR MEPContractor 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
NA
Owner - Ryan Durrant
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
3395 Henrys Fork Way
Address Line 2
rddurrant@gmail.com 9494452497
Electrical NA - Owner 6/7/2028 0.00$
Permit Information
Please enter in the following format: 00-00000
23-00354 Durrant House
3704 Henry's Fork Way
Acceptance
Sign 6/7/2023