HomeMy WebLinkAboutWORK ACCEPTANCE FORM GENESIS ELECTRIC - 23-00591 - 1132 River Ranch Rd - New SFR ElectricalContractor 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
Genesis Electric
Jared Purcell
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
216 N 300 W
Address Line 2
jaredpurcell10@gmail.com 208-681-2262
Electrical 057516 12/31/2023 $
Permit Information
Please enter in the following format: 00-00000
23-00591 1132 River Ranch Rd - New SFR Electrical
1132 River Ranch Rd
Acceptance
Sign 8/29/2023