HomeMy WebLinkAboutWORK ACCEPTANCE FORM ERICSSON - 21-00186 - T-Mobile Cell Tower - Antenna ModificationContractor 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
Ericsson
CHRIS ELDRIDGE
City
Draper
State / Province / Region
UT
Postal / Zip Code
84020
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
121 Election RD #300
Address Line 2
Christopher.x.eldridge@ericsson.com 801-564-3969
801-564-3969
Building RCE-30105 5/1/2022 15,000.00$
Permit Information
Please enter in the following format: 00-00000
21-00186 T-Mobile SL04201A
285 S 1st W
Acceptance
Sign 6/2/2021