HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELK RIDGE ELECTRIC - 21-00185 - NorthPointe Apartments - Pick Me Up - RemodelContractor 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
Elk Ridge Electric
Gary Goodnough
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
1365 W. 5500 S.,
Address Line 2
elkridgeelectric@gmail.com 2083607502
2083607502
Electrical 017404 11/30/2021 7,500.00$
Permit Information
Please enter in the following format: 00-00000
21-00185 Pick Me Up Soda
76 W 2nd S
Acceptance
Sign 4/30/2021