HomeMy WebLinkAboutWORK ACCEPTANCE FORM REXBURG PLUMBING & HEATING - 19-00447 - 236 N 3rd E - SFR to 4-PlexContractor 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
Rexburg Plumbing And Heating
Michael Mecham
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
rexburgph@gmail.com 208-356-8770
Mechanical (HVAC)hvc-c-1416 9/30/2021 1,500.00$
Permit Information
Please enter in the following format: 00-00000
19-00447 sfr to 4-plex
236 north 3rd east
Acceptance
Sign 1/16/2020