HomeMy WebLinkAboutWORK ACCEPTANCE FORM OMNI SECURITY SYSTEMS - 19-00723 - 227 E Main - Mountain America Credit Union Office - Call CenterContractor 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
Omni Security Systems inc
Mark Pettichord
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
mark.omniss@gmail.com 208 745 1020
Fire Alarm c15009 2/28/2021 15,500.00$
Permit Information
Please enter in the following format: 00-00000
19-00723 "Mountain America Credit Union Office - Call center
227 E Main St..
Acceptance
Sign 3/31/2020