HomeMy WebLinkAboutWORK ACCEPTANCE FORM EDSTROM CONSTRUCTION - 19-00447 - 236 N 3rd E - SFR to 4-PlexContractor 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
Edstrom Construction
John Edstrom
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
1305 S. 12th W.
Address Line 2
john@edstromconstruction.net 2083563577
2083518900
Building RCE-4494 1/1/2020 12,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00447 Carrie 4plex
236 N. 3RD E.
Acceptance
Sign 1/16/2020