HomeMy WebLinkAboutWORK ACCEPTANCE FORM COPPER CANYON ELECTRIC - 23-00930 - 78 W 3000 N - Shop MechanicalContractor 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
Copper Canyon Electric
Andrew Chase
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
coppercanyonelectric@yahoo.com 208-709-2387
Electrical 038628 3/31/2024 $
Permit Information
Please enter in the following format: 00-00000
23-00930 78 W 3000 N
78 W 3000 N
Acceptance
Sign 12/18/2023