HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY ELECTRIC - 23-00719 - 340 N 12th W - Mobile Home 3Contractor 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
Legacy Electric
Nick Leishman
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
ryanleishman@msn.com 208-359-9791
Electrical Ele-C-35219 6/30/2024 $
Permit Information
Please enter in the following format: 00-00000
23-00717 Mobile Homes
23-00717
Acceptance
Sign 10/6/2023