HomeMy WebLinkAboutWORK ACCEPTANCE FORM UPSTREAM PLUMBING - 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
Upstream Plumbing
Steve Billman
City
Rigby
State / Province / Region
ID
Postal / Zip Code
83442
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
3689 E 100 N
Address Line 2
billmans1@gmail.com 208-681-4169
Plumbing plb-c-12258 8/31/2024 120,175.00$
Permit Information
Please enter in the following format: 00-00000
21-00586 Just For Kids Urgent Care
1218 Bond Ave Rexburg, ID
Acceptance
Sign 9/20/2021