HomeMy WebLinkAboutWORK ACCEPTANCE FORM EMPIRE CONSTRUCTION SOLUTIONS - 20-00704 - 876 Larch Dr - Allphin ShopContractor 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
Empire Construction Solutions, LLC
Rogue Stierle
City
Idaho Falls
State / Province / Region
ID
Postal / Zip Code
83402
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
2135 Grizzly
Address Line 2
rogue.empireconst@gmail.com 12083907898
Building RCE-55263 7/9/2021 75,395.00$
Permit Information
Please enter in the following format: 00-00000
00-00000 Andy Alliphin
876 Larch Dr, Rexburg, ID 83440
Acceptance
Sign 9/14/2020