HomeMy WebLinkAboutWORK ACCEPTANCE FORM PENA VENTURES LLC - 23-00052 - 208 Physical Therapy - 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
Pena Ventures LLC
Spencer Pena
City
Rigby
State / Province / Region
Idaho
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
2spena2@gmail.com 208-403-3040
Electrical 038799 3/31/2023 3,500.00$
Permit Information
Please enter in the following format: 00-00000
23-00052 208 Physical Therapy
1120 Stocks Ave suite C
Acceptance
Sign 2/1/2023