HomeMy WebLinkAboutWORK ACCEPTANCE FORM HENRYS FORK HEATING - 21-00375 - Teton Lakes Golf Course - DeckContractor 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
Henrys Fork Heating
Jerry Phillips
City
Saint Anthony
State / Province / Region
Idaho
Postal / Zip Code
83445
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
2063 E. 600 N.
Address Line 2
henrysforkheeating@gmail.com 2082014953
Mechanical (HVAC)036334 12/31/2021 $
Permit Information
Please enter in the following format: 00-00000
21-00375 Golf course deck remodel
722 N12th W. Rexburg
Acceptance
Sign 8/11/2021