HomeMy WebLinkAboutWORK ACCEPTANCE FORM REXBURG PLUMBING AND HEATING - 22-00292 - Chad Erickson - New Commercial BldgContractor 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
Rexburg Plumbing and Heating
Nephi Allen
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
Madison
Update new contact information that is not already on file with the City of Rexburg
Street Address
PO Box 759
Address Line 2
rexburgph@gmail.com 208-356-8770
Plumbing PLB-C-13439 10/31/2023 $
Mechanical (HVAC)039671 12/31/2024 $
Permit Information
Please enter in the following format: 00-00000
22-00292 Chad Erickson New Commercial Bldg
309 Profit St
Acceptance
Sign 5/17/2022