HomeMy WebLinkAboutWORK ACCEPTANCE FORM DOUG'S REPAIR - 21-00321 - Crush Artisanal Drinks - 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
Doug's Repair
Angel Ruiz
City
ID
State / Province / Region
IDAHO
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
418 N 4014 E
Address Line 2
STE #4
dispatch@dougsrepair.com 2083569331
Plumbing PLB-C-13418 2/28/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00321 Crush
155 W Main St
Acceptance
Sign 8/12/2021