HomeMy WebLinkAboutWORK ACCEPTANCE FORM BROKEN ARROW COMMUNICATIONS - 20-00936 - Cell Tower - Antenna Addition/ReplacementContractor 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
Broken Arrow Communications
Ryan Clausen
City
Nampa
State / Province / Region
Idaho
Postal / Zip Code
83651
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
3301 Caldwell Blvd.
Address Line 2
rclausen@bacom-inc.com 208-800-1431
Electrical RCE-274 1/31/2021 25,000.00$
Permit Information
Please enter in the following format: 00-00000
20-00936 SL01403D
12 North Main Street
Acceptance
Sign 12/16/2020