HomeMy WebLinkAboutWORK ACCEPTANCE FORM MATHEWS PLUMBING & HEATING - 19-00662 - 890 W Main - Grind Coffee House - Electrical - PlumbingContractor 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
Mathews Plumbing & Heating Inc
Mike Balmforth
City
Shelley
State / Province / Region
ID
Postal / Zip Code
83274
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
342 S State St
Address Line 2
mike@mathewsplumbing.net 12085898395
12085898395
Plumbing PLB-C-11778 2/28/2022 2,500.00$
Permit Information
Please enter in the following format: 00-00000
19-00662 The Grind Coffee House
890 W Main, Rexburg ID 83440
Acceptance
Sign 10/25/2019