HomeMy WebLinkAboutWORK ACCEPTANCE FORM SUMMERS PLUMBING - 21-00185 - NorthPointe Apartments - Pick Me Up - RemodelContractor 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
Summers plumbing
Casey
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
summersplbg@gmail.com 208-221-3837
Plumbing Plb-c-9233 6/3/2022 4,500.00$
Permit Information
Please enter in the following format: 00-00000
21-00185 Pick me up
76 w. 2nd s rexburg
Acceptance
Sign 5/19/2021