HomeMy WebLinkAboutWORK ACCEPTANCE FORM HEADWATERS CONSTRUCTION - 23-00170 - Rexburg 10 Ward LDS MeetinghouseContractor 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
Headwaters Construction
Cody Summers
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
900 Jet Stream Drive
Address Line 2
csummers@headwaterscc.com 866-496-9868
2085217228
Building REC-60518 12/13/2023 11,822,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00170 Rexburg 10th Ward Custom Meeting House
411 University Blvd. Rexburg, Idaho 83440
Acceptance
Sign 6/6/2023