HomeMy WebLinkAboutWORK ACCEPTANCE FORM CONAN INC - 23-00605 - Dutch Bros - New Commercial BldgContractor 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
Conan Inc.
Loni Miller
City
Idaho Falls
State / Province / Region
ID
Postal / Zip Code
83402
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
429 W 18th Street
Address Line 2
lonih551@msn.com 2085223372
2085223372
Mechanical (HVAC)HVC-C-1512 9/30/2025 22,500.00$
Permit Information
Please enter in the following format: 00-00000
23-00605 Dutch Bros.
855 W Main
Acceptance
Sign 4/10/2024