HomeMy WebLinkAboutWORK ACCEPTANCE FORM REXBURG PLUMBING - 22-00523 - Northwest Farm Credit Services - RemodelContractor 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 State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
rexburgph@gmail.com 208-356-8770
Plumbing PLB-C-13439 10/31/2023 12,168.00$
Permit Information
Please enter in the following format: 00-00000
22-00523 Northwest Farm Credit
Erickson Dr
Acceptance
Sign 9/6/2022