HomeMy WebLinkAboutWORK ACCEPTANCE FORM REXBURG PLUMBING & HEATING (HVAC) - 20-00413 - 425 Harvard Ave - Blake Willis - Duplex Bldg 3Contractor 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
Rexburg Plumbing & Heating
Nephi Allen
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
rexburgph@gmail.com 208-356-8770
Mechanical (HVAC)039671 8/31/2022 $
Permit Information
Please enter in the following format: 00-00000
20-00169 Blake Willis - Duplex
425 Harvard Ave 1001,1101
Acceptance
Sign 6/16/2021