HomeMy WebLinkAboutWORK ACCEPTANCE FORM HOLESHOT PLUMBING - 20-00248 - Vista Medical OfficeContractor 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
Holeshot Plumbing
Dale S Johnson
City
Ammon
State / Province / Region
Idaho
Postal / Zip Code
83406
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
3968 East Sunnyside Road Unit 1
Address Line 2
holeshotplumbing@gmail.com 208-535-1300
208-317-1001
Plumbing PLB-C-11517 11/30/2021 33,620.00$
Permit Information
Please enter in the following format: 00-00000
20-00251 Vista Medical
570 Trejo St. Rexburg, Idaho
Acceptance
Sign 6/8/2020