HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELK RIDGE ELECTRIC - 22-00165 - 250 W Main - Mobile Vending CourtContractor 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
Elk Ridge Electric
Gary Goodnough
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
elkridgeelectric@gmail.com 208-360-7502
Electrical 017404 11/30/2022 6,500.00$
Permit Information
Please enter in the following format: 00-00000
22-00165 Mobile Vending Court
250 W Main
Acceptance
Sign 4/1/2022