HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLASER CONSTRUCTION - 21-00589 - Madison Armory - Indoor Gun RangeContractor 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 acknowledge that I am the indicated contractor for the above mentioned Permit/Project.
Signature Date
Contractor/Subcontractor
Blaser Construction LLC
Marty Blaser
City State / Province / Region
Postal / Zip Code Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
moosebl3@hotmail.com 208-390-1737
Building RCE-35367 5/31/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00589 Maison Armory Gun Range
870 N 2nd E
Acceptance
Sign 9/17/2021