HomeMy WebLinkAboutWORK ACCEPTANCE FORM MARTINEAU ELECTRIC - 20-00700 - Kodiak LLC - Gorilla PerformanceContractor 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 acknowle dge that I am the indicate d contractor for the abov e me ntione d Pe rmit/Proje ct.
Signature Date
Contractor/Subcontractor
Martineau Electric
Ferron Martineau
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
martineauelectric@msn.com 390-2126
Electrical C-25875 1/31/2022 $
Permit Information
Please enter in the following format: 00-00000
20-00700 Kodiak - Gorilla Performance
911 Jet Stream Dr
Acceptance
Sign 3/4/2021