HomeMy WebLinkAboutWORK ACCEPTANCE FORM MIDWEST D-VISION SOLUTIONS - 21-00250 - BYUI Manwaring Center Activities & Involvement - 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
Midwest D-Vision Solutions
Jacob Altrogge
City
BOISE
State / Province / Region
ID
Postal / Zip Code
83705
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
509 W McGregor Court
Address Line 2
jacoba@mwdsidaho.com 2085056333
Building RCE-53520 1/6/2022 34,099.00$
Permit Information
Please enter in the following format: 00-00000
21-00250 BYU-Idaho MC Activities Center Remodel
101 E Viking St Drive, Rexburg, ID 83460
Acceptance
Sign 6/2/2021