HomeMy WebLinkAboutWORK ACCEPTANCE FORM MOUNTAIN VALLEY ELECTRIC - 23-00605 - Dutch Bros - New Commercial BldgContractor 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
Mountain Valley Electric
Nick Barnett
City
Rigby
State / Province / Region
Idaho
Postal / Zip Code
83442
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
3880 East 200 North
Address Line 2
nick@mountainvalleyelectric.com 2089704686
Electrical 021047 10/28/2024 98,589.00$
Permit Information
Please enter in the following format: 00-00000
23-00605 Dutch Brothers
855 W. Main Street
Acceptance
Sign 4/9/2024