HomeMy WebLinkAboutWORK ACCEPTANCE FORM SPRINKLER MEDIX - 22-00289 - 2412 W 880 S - Lawn SprinklerContractor 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
sprinkler Medix
Boden Huffaker
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
545 Linden Ave
Address Line 2
sprinklermedix@gmail.com 2086565950
2087400473
Building RCE-61812 6/2/2023 20,000.00$
Permit Information
Please enter in the following format: 00-00000
12-34567 NA
NA
Acceptance
Sign 6/16/2022