HomeMy WebLinkAboutWORK ACCEPTANCE FORM PATRIOT PLUMBING - 21-00628 - 1105 Larch Dr - New SFRContractor 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
Patriot Plumbing LLC
John Behm
City
Shelley
State / Province / Region
Id
Postal / Zip Code
83274
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
345 meadowlark dr.
Address Line 2
Patriotplumbing34@gmail.com 208-346-2474
Same
Plumbing 018654 6/30/2022 0.00$
Permit Information
Please enter in the following format: 00-00000
21-00628 Aeryk checketts
1105 larch dr.
Acceptance
Sign 8/31/2021