HomeMy WebLinkAboutWORK ACCEPTANCE FORM TC PLUMBING - 20-00297 - 460 S 4th E - SFR Remodel (2)Contractor 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
TC Plumbing
Tracy Clark
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
pipewrench1970@gmail.com 208-709-7343
Plumbing PLB-C-12175 2/28/2021 $
Permit Information
Please enter in the following format: 00-00000
20-00297 Kent Hayes
460 S 4th E
Acceptance
Sign 7/23/2020