HomeMy WebLinkAboutWORK ACCEPTANCE FORM TILSON TECHNOLOGY MANAGEMENT, INC - 19-00397 - T-Mobile Cell Tower - Parts Change-outContractor 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
TILSON TECHNOLOGY MANAGEMENT, INC
JAY COOPER
City
Portland
State / Province / Region
ME
Postal / Zip Code
04101
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
16 Middle ST 4th Flr
Address Line 2
JCOOPER@TILSONTECH.COM 435-773-8303
Electrical 10425708-5551 4/30/2021 $
Permit Information
Please enter in the following format: 00-00000
19-00397 Tmobile cell tower parts changeout
320 Barney Dairy RD
Acceptance
Sign 9/10/2020