HomeMy WebLinkAboutWORK ACCEPTANCE FORM LUCKY - 23-00723 - 4253 W 2000 S - Shop 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
Lucky
Troy Dennis Osullivan
City
terreton
State / Province / Region
id
Postal / Zip Code
83450
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
1150e 1500n
Address Line 2
luckyelectricllc@gmail.com 2083600376
2083600376
Electrical 057626 12/31/2023 $
Permit Information
Please enter in the following format: 00-00000
23-00723 Eric Barzee Shop
4253 W 2000 S
Acceptance
Sign 10/4/2023