HomeMy WebLinkAboutWORK ACCEPTANCE FORM MONTEC SERVICES INC - 21-00372 - Crown Castle/T-Mobile Cleartalk - 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 acknowledge that I am the indicated contractor for the above mentioned Permit/Project.
Signature Date
Contractor/Subcontractor
Montec Services Inc
Kaydi Titchbourne
City
Eureka
State / Province / Region
MT
Postal / Zip Code
59917
Country
US
Update new contact information that is not already on file with the City of Rexburg
Street Address
1005 Iowa Flats Rd
Address Line 2
kaydi@montecservices.com 4696820812
Building RCE-41117 1/20/2022 $
Permit Information
Please enter in the following format: 00-00000
21-00372 Cleartalk Rexburg
320 Barney Dairy Road
Acceptance
Sign 11/23/2021