HomeMy WebLinkAboutWORK ACCEPTANCE FORM ACOUSTIC SPECIALTIES INC - 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
Acoustic Specialties Inc
Joe Lazdauskas
City
Pocatello
State / Province / Region
ID
Postal / Zip Code
83205
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
P.O. Box 4135
Address Line 2
joelazasi@gmail.com 2082415308
2082415308
Building RCE-5070 1/24/2025 9,068.00$
Permit Information
Please enter in the following format: 00-00000
23-00937 Madison Memorial Surgery Center
381 E. 4th N. Rexburg, ID
Acceptance
Sign 2/9/2024