HomeMy WebLinkAboutWORK ACCEPTANCE FORM HOLESHOT PLUMBING - 19-00364 -East Idaho Credit Union - New BuildingContractor 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
Holeshot Plumbing
Dale S Johnson
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
holeshotplumbing@yahoo.com 208-317-1001
Plumbing PLB-C-11517 11/30/2021 10,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00364 East Idaho Credit Union
310 N. 2nd E.
Acceptance
Sign 7/11/2019