HomeMy WebLinkAboutWORK ACCEPTANCE FORM JB KAY CONSTRUCTION - 19-00590 - Fullmer - Medical Office 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
J. B. Kay Construction, LLC
Jared B. Kay
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
US
Update new contact information that is not already on file with the City of Rexburg
Street Address
950 Vista Ave
Address Line 2
jared@jbkayconstruction.com 2087162374
Building RCE-35095 3/25/2020 $
Permit Information
Please enter in the following format: 00-00000
19-00590 Henry's Fork Surgery
28 N. 12th West
Acceptance
Sign 1/28/2020