HomeMy WebLinkAboutWORK ACCEPTANCE FORM ARCHIBALD PLUMBING - 19-00504 - 273 S 5th W - Campus Courtyard - RemodelContractor 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
archibald plumbing
brad archibald
City
rexburg
State / Province / Region
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
843 n 5 th west
Address Line 2
archiplumb@hotmail.com 2083904460
Plumbing plb-c-11486 9/30/2021 10,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00504 barrick shop
273 so 5th west
Acceptance
Sign 9/25/2019