HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEGACY TELECOMMUNICATIONS - 21-00209 - 12 N Center St - Cell TowerContractor 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
Legacy Telecommunications
Brian Villalba
City
Nampa
State / Province / Region
ID
Postal / Zip Code
83687
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
2024 N Elder St
Address Line 2
brian.villalba@legacytowers.com 2087032183
Building RCE-19785 12/19/2021 9,500.00$
Permit Information
Please enter in the following format: 00-00000
21-00209 Cellphone Tower Microwave Add
12 N Center St
Acceptance
Sign 8/16/2021