HomeMy WebLinkAboutWORK ACCEPTANCE FORM RUSSELL ELECTRIC LLC - 21-01027 - 1139 Greenside Loop - 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
RUSSELL ELECTRIC LLC.
dOUG RUSSELL
City
IDAHO FALLS
State / Province / Region
IDAHO
Postal / Zip Code
83401
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
2239 TIMBERVIEW DR
Address Line 2
russellelectricpower@gmail.com 208-709-7458
Electrical ELE-C-33253 4/30/2023 $
Permit Information
Please enter in the following format: 00-00000
21-01027 TWEBB CONST
1139 GREENSIDE LOOP
Acceptance
Sign 7/10/2023