HomeMy WebLinkAboutWORK ACCEPTANCE FORM TOD SHIRLEY CONSTRUCTION - 19-00097 - 3653 Yosemite Cir - New SFRContractor 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
Tod Shirley Construction
Tod Shirley
City
Sugar City
State / Province / Region
Idaho
Postal / Zip Code
83448
Country
Madison
Update new contact information that is not already on file with the City of Rexburg
Street Address
2997 N. 5000 E.
Address Line 2
surelybuilt@yahoo.com 208-356-9674
208-709-1304
Building RCE-30709 9/8/2020 $
Permit Information
Please enter in the following format: 00-00000
19-00097 Anderson
3653 Yosemite Cir
Acceptance
Sign 2/25/2020