HomeMy WebLinkAboutWORK ACCEPTANCE FORM ROCK CREEK FIRE PROTECTION - 20-00735 - Teton River Flats Community HousingContractor 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
Rock Creek Fire Protection
Shane Broderick
City
Rockland
State / Province / Region
ID
Postal / Zip Code
83271
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
P.O. Box 637
Address Line 2
shane@rockcreekfire.com 208-479-2798
same
Fire Sprinkler FPSC#116 12/31/2021 7,143.00$
Permit Information
Please enter in the following format: 00-00000
20-00735 TETON RIVER FLATS
280 LORENE STREET
Acceptance
Sign 2/23/2021