HomeMy WebLinkAboutWORK ACCEPTANCE FORM SAC WIRELESS (CAN'T FIND LICENSE IN SYSTEM) - 19-00397 - 320 Barney Dairy Rd - T-Mobile Cell Tower Parts ChangeoutContractor 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
SAC Wireless
Darin Pinkham
City
Phoneix
State / Province / Region
AZ
Postal / Zip Code
85016
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
2415 East Camelback Rd
Address Line 2
Suite 700
darin.pinkham@sacw.com 480-544-0772
Building 269379 6/30/2020 25,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00397 N. Rexburg
320 Barney Dairy Road
Acceptance
Sign 7/29/2019