HomeMy WebLinkAboutWORK ACCEPTANCE FORM UNCOMMON BUILDERS - 22-00034 - Nitro Car WashContractor 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
UnCommon Builders LLC
Kerry Adolfson
City
Firth
State / Province / Region
ID
Postal / Zip Code
83236
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
1054 N 575 E
Address Line 2
uncommonbuilders@gmail.com 2085419823
2085419823
Building REC-55880 9/9/2022 $
Permit Information
Please enter in the following format: 00-00000
22-00034 Nitro carwash
1371n 2nd e Rexburg 83440
Acceptance
Sign 1/20/2022