HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELK RIDGE ELECTIRC - 23-00018 - Romance Theatre - Remodel Phase 3Contractor 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
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
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 208-360-7502
Electrical 017404 11/30/2023 8,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00018 Romance Theatre - Remodel phase 3
4 E Main St
Acceptance
Sign 1/13/2023