HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEISURE TIME - 20-00872 - 2234 Ferris Ln - MechanicalContractor 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
Leisure time
Deija Simmons
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
Deija.Simmons@leisuretimeinc.com 2085234633
Mechanical (HVAC)005885 11/4/2021 $
Permit Information
Please enter in the following format: 00-00000
20-00872 woodstove
2234 ferris ln
Acceptance
Sign 11/5/2020