HomeMy WebLinkAboutWORK ACCEPTANCE FORM PREMIUM SPECIALTIES CONSTRUCTION LLC - 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
Premium specialties construction llc
Ector j orozco
City
Idaho falls
State / Province / Region
Id
Postal / Zip Code
83404
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
1305 noxon ave
Address Line 2
Premiumspecialtiesco@gmail.com 2083461428
Building Rce38461 11/7/2021 $
Permit Information
Please enter in the following format: 00-00000
21-00321 Crush artisans drinks remodel
155 w. Main St. 5
Acceptance
Sign 9/3/2021