HomeMy WebLinkAboutWORK ACCEPTANCE FORM HOUSLEY PUMPS - 22-00405 - 210 W 2nd N - Water LineContractor 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
Housley Pumps Inc
RICHARD HOUSLEY
City
SAINT ANTHONY, ID
State / Province / Region
ID
Postal / Zip Code
83445
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
40 West Main
Address Line 2
Saint Anthony, Idaho
hpumps@netscape.net 12086243772
Plumbing PLB-C-9265 2/28/2024 2,000.00$
Permit Information
Please enter in the following format: 00-00000
22-00405 UVPM #10
210 W 2ND N REXBURG, ID 83440
Acceptance
Sign 6/9/2022