HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEWIS CORPORATION - 23-00937 - Madison Health Surgery Center - MechanicalContractor 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
Lewis Corporation
Lewis Corporation
City
POCATELLO
State / Province / Region
ID
Postal / Zip Code
83202
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
15136 W Hunziker Road
Address Line 2
heidi@lcorp.com 2082381202
Mechanical (HVAC)HVC-C4440 9/30/2024 159,150.00$
Permit Information
Please enter in the following format: 00-00000
23-00937 Madison Health Surgery
381 E 4th North
Acceptance
Sign 12/27/2023