HomeMy WebLinkAboutWORK ACCEPTANCE FORM LIBERTY PLUMBING - 21-00055 - 941 Oak Hill Way - New SFRContractor 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
Liberty plumbing LLC
Jason Wistisen
City
Blackfoot
State / Province / Region
Id
Postal / Zip Code
83221
Country
Bingham
Update new contact information that is not already on file with the City of Rexburg
Street Address
431W 300 N.
Address Line 2
libertyplumbingllc@yahoo.com 208-604-5441
Plumbing Plb-c-12663 12/31/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00055 Haney
941 Oak Hill Way
Acceptance
Sign 1/28/2021