HomeMy WebLinkAboutWORK ACCEPTANCE FORM MODERN PLUMBING & HEATING DBA HIGH COUNTRY HEATING 1 - 19-00359 - 871 Jet Stream Dr - The Rock Gym - New CommercialContractor 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
Modern plumbing and heating dba high country heating
Jenni garner
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
office@modernphe.com 208-745-7021
Plumbing Plb-c-9441 8/31/2019 15,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00359 Jetstream
869 jetstream
Acceptance
Sign 6/26/2019