HomeMy WebLinkAboutWORK ACCEPTANCE FORM CHAPPELL CONSTRUCTION - 21-00217 - The Veld LLC - 18 E Main - SignContractor 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
Chappell Construction
Justin Chappell
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
chappellconstructioncompany@gmail.com 2086809388
Building RCT-50776 11/26/2021 200.00$
Permit Information
Please enter in the following format: 00-00000
21-00217 The Veld LLC
18 E Main, Rexburg, ID 83440
Acceptance
Sign 4/7/2021