HomeMy WebLinkAboutWORK ACCEPTANCE FORM BYUI MECHANICAL - 19-00282 - BYUI Fleet Department Shop - 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 acknowle dge that I am the indicate d contractor for the abov e me ntione d Pe rmit/Proje ct.
Signature Date
Contractor/Subcontractor
BYU Idaho
Sam Merrick
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83460
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
525 S Center
Address Line 2
merricks@byui.edu 208-496-2570
208-201-6046
Mechanical (HVAC)006115 10/31/2021 $
Permit Information
Please enter in the following format: 00-00000
19-00282 Fleet Department AC
525 S Center
Acceptance
Sign 5/17/2019