HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY FIRE PROTECTION - 23-00037 - Rexburg Pediatrics - 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
Legacy Fire Protection
Austin Stuart Hayward
City
Idaho Falls
State / Province / Region
Idaho
Postal / Zip Code
83402
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
234 W 18th St
Address Line 2
austin.hayward@chfire.us 2083134987
208 313 4987
Fire Sprinkler FPSC - 166 12/31/2023 15,224.00$
Permit Information
Please enter in the following format: 00-00000
23-00037 Rexburg Pediatric Remodel
404 N 2nd E / Rexburg, ID 83440
Acceptance
Sign 2/6/2023