HomeMy WebLinkAboutWORK ACCEPTANCE FORM M DENT - 22-00789 - 1183 Summers Dr - Egress WindowsContractor 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
M Dent
Mike Merrell
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
1183 Summers Dr
Address Line 2
mdentinc2007@yahoo.com 2083569097
Building 00000000000000000000 10/27/2022 3,000.00$
Permit Information
Please enter in the following format: 00-00000
22-00789 Egress windows
1183 Summers Drive
Acceptance
Sign 10/27/2022