HomeMy WebLinkAboutWORK ACCEPTANCE FORM STEELHEAD COMMUNICATIONS INC - 19-00414 - 230 Tower Rd - Cell TowerContractor 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
Steelhead Communications Inc
Chase Jacobson
City
Buckley
State / Province / Region
Wa
Postal / Zip Code
98321
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
28120 state route 410 E
Address Line 2
Chasej@steelheadcom.com 406-240-9195
406-240-9195
Building RCE-13190 2/21/2020 42,200.00$
Permit Information
Please enter in the following format: 00-00000
19-00414 ID6 Madison
230 tower road (249 Erickson Dugway rd)
Acceptance
Sign 2/4/2020