HomeMy WebLinkAboutWORK ACCEPTANCE FORM TETON WEST OF IDAHO - 19-00359 - 871 Jet Stream Dr - The Rock Gym - New CommercialContractor 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
Teton West of Idaho
Steve Wilcox
City
Rigby
State / Province / Region
Idaho
Postal / Zip Code
83442
Country
Jefferson
Update new contact information that is not already on file with the City of Rexburg
Street Address
P.O. Box 176
Address Line 2
sw.tetonwest@gmail.com 208-709-7553
Building Rce7170 2/7/2020 705,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00359 Clark Hamilton
869 Jet Stream Dr
Acceptance
Sign 6/27/2019