HomeMy WebLinkAboutWORK ACCEPTANCE FORM VALLEYWIDE COOP- 21-00216 - Valley Agronomics - Maintenance ShopContractor 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
Valleywide Coop
John Huskinson
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
520 E Moody Rd
Address Line 2
john.huskinson@valleywidecoop.com 208-390-2629
Mechanical (HVAC)HVC-C-3314 5/31/2024 12,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00216 Valley Agronomics - Maintenance Shop
1350 Thomopson St
Acceptance
Sign 2/15/2022