HomeMy WebLinkAboutWORK ACCEPTANCE FORM XTREME ELECTRIC - 23-00463 - Bodifi - 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
Xtreme Electric
Blake Larsen
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
extreme3003@gmail.com 208-313-3003
Electrical ELE-C-27283 10/31/2023 5,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00463 Bodifi
730 W 7th S
Acceptance
Sign 8/2/2023