HomeMy WebLinkAboutWORK ACCEPTANCE FORM COPPER CANYON ELECTRIC LLC - 22-00457 - Herndon Apartments - Walsh - Townhomes - 4 UnitsContractor 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 LLC
Andy Chase
City
Rigby
State / Province / Region
ID
Postal / Zip Code
83442
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
4093 E 370 N
Address Line 2
coppercanyonelectric@yahoo.com 2087092387
Electrical 038628 3/1/2025 23,000.00$
Permit Information
Please enter in the following format: 00-00000
22-00457 Herndon Apartments
263 s 4th w
Acceptance
Sign 4/5/2024