HomeMy WebLinkAboutAPPLICATION - 04-00218 - JN Masonry - Business ApplicationI°
Name of Business
Location:
Type of .construct
Person applying:_
Rexburg Address:
Other Address: ZSQ
(Mailing address, city, state & zip)
Home Phone: ° Moll Business Phone • O$0Lj
Mobile Phone: � 'S1 l Q S( Fax:
Location of previous business: I O1'lt,
Drivers License Number:
State: T 2ibQ Date of Birth:
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Sla Tax I.D. Number:
S.S 4fr " tq • 5-3 • ps i ga
Nearest friend or relative:
(address, city, state, zip)
References if new business:
�YEWI M
wit,
Amount of license: jj J
Comments:
Signature: T QOk AJg \/.j c e-r& Date:
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( SSta, �
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Approve(f Date
CITY OF REXBURG
CONTRACTOR BUSINESS LICENSE APPLICATION