HomeMy WebLinkAboutWORK ACCEPTANCE FORM SLATE MOUNTAIN HOMES - 21-00242 - 320 Bluebell St - Mobile HomeContractor 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
Slate Mountain Homes
Fred Dummar
City
Idaho Falls
State / Province / Region
ID
Postal / Zip Code
83404
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
375 Castlerock Lane
Address Line 2
fred@alpinecs.com 9102614035
Building 052092 5/26/2021 9,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00242 320 Bluebell
320 Bluebell St Rexburg, ID 83440
Acceptance
Sign 5/26/2021