HomeMy WebLinkAboutWORK ACCEPTANCE FORM HOLESHOT PLUMBING - 23-00697 - Chip Cookie - 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
Holeshot Plumbing
Dale Johnson
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
dale@holeshotplumbing.org 208-317-1001
Plumbing plb-c-11517 11/30/2024 18,500.00$
Permit Information
Please enter in the following format: 00-00000
23-00697 Chip Cookie - Remodel
505 N 2nd E, Ste 203
Acceptance
Sign 10/23/2023