HomeMy WebLinkAboutWORK ACCEPTANCE FORM GL EDWARDS - 23-00400 - 335 Yale Ave - Porch with RoofContractor 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
GL Edwards
LeRoy Edwards
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
gledwardselectric@gmail.com 403-9614
Electrical 27774 7/20/2024 $
Permit Information
Please enter in the following format: 00-00000
23-00400 335 Yale
Angie McComber
Acceptance
Sign 12/13/2023