HomeMy WebLinkAboutWORK ACCEPTANCE FORM TC PLUMBING - 21-00483 - 168 E 2nd S - 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
TC Plumbing
Tracy Clark
City
Sugar City
State / Province / Region
Idaho
Postal / Zip Code
83448
Country
Madison
Update new contact information that is not already on file with the City of Rexburg
Street Address
5572 E. 3000 N.
Address Line 2
pipewrench1970@gmail.com 208-709-7343
Plumbing PLB-C-12175 2/28/2024 10,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00483 Bown
168 E. 2nd S. Rexburg
Acceptance
Sign 6/30/2021