HomeMy WebLinkAboutWORK ACCEPTANCE FORM MILLER PLUMBING - 20-00060 - 720 S 5th W Units 1 & 2 - New Duplex - Bldg 2Contractor 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
Miller Plumbing
Jay Miller
City
St. Anthony
State / Province / Region
ID
Postal / Zip Code
83445
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
518 Hawks Rest Circle
Address Line 2
arcticcatm7@yahoo.com 2083904063
Plumbing Plb-c-12162 2/28/2022 20,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00060 Twin home
720 S 5th W
Acceptance
Sign 3/18/2020