HomeMy WebLinkAboutWORK ACCEPTANCE FORM JOHNSON HEATING - 19-00165 - 651 W Main St - Block Building - DuplexContractor 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
Johnson heating
Andy Johnson
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
Uss
Update new contact information that is not already on file with the City of Rexburg
Street Address
985 Hillview drive
Address Line 2
Johnsonheating@msn.com 208-390-0525
Mechanical (HVAC)HVC-C-1327 8/31/2021 12,500.00$
Permit Information
Please enter in the following format: 00-00000
19-00165 Marshall ricks
Main Street, Rexburg
Acceptance
Sign 5/8/2019