HomeMy WebLinkAboutWORK ACCEPTANC FORM LEGACY ELECTRIC - 23-00874 - 893 Oak Hill Way - New SFRContractor 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
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
4455 Jud st
Address Line 2
nickleishman@gmail.com 2087160420
Electrical 35219 6/10/2028 23,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00874 Bridger jacobs
Pine brook estates
Acceptance
Sign 1/29/2024