HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLANE ROBBINS ELECTRIC, INC - 23-00753 - Pebble Creek Townhomes - 6 Plex - Bldg 1Contractor 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
Blane Robbins Electric, Inc.
Jeremy Robbins
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
431 W 100 N
Address Line 2
brobbinselectric.bre@gmail.com 2087854674
Electrical ELE-C-12881 12/31/2024 53,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00753 Pebble Creek
1410 Smith Ranch Rd
Acceptance
Sign 4/17/2024