HomeMy WebLinkAboutWORK ACCEPTANCE FORM LIBERTY PLUMBING LLC - 23-00730 - Clubhouse Dental - 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
Liberty Plumbing llc
Jason Wistisen
City
Blackfoot
State / Province / Region
ID
Postal / Zip Code
83221
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
431w 300n
Address Line 2
431 W 300 N
libertyplumbingllc@yahoo.com 2086045441
Plumbing plb-c-12663 12/31/2025 88,500.00$
Permit Information
Please enter in the following format: 00-00000
23-00730 Jason Wistisen
431 W 300 N
Acceptance
Sign 5/29/2024