HomeMy WebLinkAboutWORK ACCEPTANCE FORM LUXURY HEATING AND AIR - 23-00898 - 817 Lincoln Ln - New SFR MEPContractor 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
Luxury Heating and Air
Jacob Gilbert
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
jacobg@myluxuryheating.com 208-525-8722
Mechanical (HVAC)HVC-C-2817 3/31/2027 12,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00898 817 Lincoln Ln - New SFR MEP
817 Lincoln Ln
Acceptance
Sign 4/2/2024