HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEWIS CORPORATION - 21-00586 - Just4Kids Pediatric Urgent CareContractor 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 acknowledge that I am the indicated contractor for the above mentioned Permit/Project.
Signature Date
Contractor/Subcontractor
Lewis Corporation
Kenyan Lewis
City
Pocatello, Idaho 83202
State / Province / Region
ID
Postal / Zip Code
83202
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
15136 W Hunziker Road
Address Line 2
kenayn@lcorp.com 2082381202
2082381202
Mechanical (HVAC)HVC-C4440 9/30/2022 106,750.00$
Permit Information
Please enter in the following format: 00-00000
21-00586 Just 4 Kids - Rexburg
1218 Bond
Acceptance
Sign 9/20/2021