HomeMy WebLinkAboutWORK ACCEPTANCE FORM LIBERTY VALLEY - 21-00233 - 250 E 3rd S - RemodelContractor 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
Liberty Valley Co.
Alexander Hall
City
Rexburg
State / Province / Region
Idaho
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
237 N 2nd E
Address Line 2
Suite 214
libertyvalleyco@gmail.com 2085413439
Building RCE-55094 6/23/2021 10,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00233 Kryst Krein
250 E 3rd S
Acceptance
Sign 4/13/2021