HomeMy WebLinkAboutWORK ACCEPTANCE FORM OMNI SECURITY - 20-00273 - Madison High School Field HouseContractor 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
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 208745-1020
Fire Alarm ELE-C-15009 2/28/2022 $
Permit Information
Please enter in the following format: 00-00000
20-00273 Madison High School Fieldhouse
2300 University Blvd
Acceptance
Sign 2/2/2021