HomeMy WebLinkAboutWORK ACCEPTANCE FORM REXBURG PLUMBING & HEATING (PLUMBING) - 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
Rexburg Plumbing and Heating
nephi
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
766 N Yellowstone Hwy
Address Line 2
eacjones@gmail.com 2086200500
Plumbing plb-c-13439 10/31/2022 25,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00590 fullmer
main and 12th
Acceptance
Sign 1/30/2020