HomeMy WebLinkAboutWORK ACCEPTANCE FORM ROCY MOUNTAIN ELECTRIC, INC - 23-00937 - Madison Health Surgery Center - MechanicalContractor 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
Rocky Mountain Electric, Inc.
BRIANT LEE BOREN
City
Idaho Falls
State / Province / Region
ID
Postal / Zip Code
83401-5744
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
6698 N 25th E
Address Line 2
rmeidanet@gmail.com 2085896826
Electrical 18230 3/31/2024 14,700.00$
Permit Information
Please enter in the following format: 00-00000
23-00937 Rexburg Surgical Cetnter
381 E 4th N
Acceptance
Sign 2/12/2024