HomeMy WebLinkAboutWORK ACCEPTANCE FORM ELK RIDGE ELECTRIC - 22-00821 - Shelfology - AdditionContractor 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 10,000.00$
Permit Information
Please enter in the following format: 00-00000
22-00821 Shelfology - Addition
156 N 2nd E
Acceptance
Sign 1/25/2023