HomeMy WebLinkAboutWORK ACCEPTANCE FORM MIKE WOOD HEATING & COOLING - 20-00028 - 430 W 5th S, #501 - Rexburg Plaza Bathroom 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
mike wood heating and cooling
mike wood
City
sugar city
State / Province / Region
id
Postal / Zip Code
83448
Country
madison
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
po box 188
mikewhvac@cableone.net 208 390 6669
2083906669
Mechanical (HVAC)hvc-c-2235 10/31/2022 100.00$
Permit Information
Please enter in the following format: 00-00000
20-00028 rexburg plaza
430 w 5th s rexburg
Acceptance
Sign 3/5/2020