HomeMy WebLinkAboutWORK ACCEPTANCE FORM 3-D FIRE PROTECTION - 19-00154 - 1450 N 2nd E - Walmart - Grocery Pickup AdditionContractor 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
3-D Fire Protection
Kelly Bateman
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
kelly.bateman@3dfire.us 208-525-8377
Fire Sprinkler FPSC-008 12/31/2019 $
Permit Information
Please enter in the following format: 00-00000
19-00154 Rexburg Walmart Online Grocery Pickup
1450 N. 2nd E.
Acceptance
Sign 9/23/2019