HomeMy WebLinkAboutWORK ACCEPTANCE FORM HARRIS MOUNTAIN WEST - 23-00814 - Madison County Dispatch - 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
Harris Mountain West
Brandon Rice
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
532 W Hwy 39
Address Line 2
bnrice@harriscompany.com 208-760-8140
Mechanical (HVAC)HVC-C-5365 10/31/2026 $
Permit Information
Please enter in the following format: 00-00000
23-00814 Madison County Dispatch - Electrical
129 E Main St
Acceptance
Sign 12/21/2023