HomeMy WebLinkAboutWORK ACCEPTANCE FORM JP CUSTOMS LLC - 23-00729 - 257 Marianne Dr - Duplex ConversionContractor 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
JP Customs LLC
Jason Park
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
jpcustoms21@gmail.com 208-313-0388
Electrical 068192 9/30/2024 $
Permit Information
Please enter in the following format: 00-00000
23-00729 257 Marianne Dr - Duplex
257 Marianne Dr
Acceptance
10/12/2023