HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00638 - 1145 S 2nd E - Cell Tower - Dish WirelessContractor 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 acknowle dge that I am the indicate d contractor for the abov e me ntione d Pe rmit/Proje ct.
Signature Date
Contractor/Subcontractor
Anchor Electric Contracting Corp
Josh Forshee
City
Missoula
State / Province / Region
MT
Postal / Zip Code
59808
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
7600 Pontrelli Place
Address Line 2
lisa@anchorlt.com 4062513166
Electrical 014382 4/30/2020 $
Permit Information
Please enter in the following format: 00-00000
18-00638 ID1480001A
1145 South 2nd St E, Rexburg ID 83440
Acceptance
Sign 4/29/2019