HomeMy WebLinkAbout19-00081 Contractor Info Form Steelhead Communications Inc..pdfContractor 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
Steelhead Communications Inc.
Jolene Moorehouse
City
Buckley
State / Province / Region
WA
Postal / Zip Code
98321
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
28120 State Route 410 E
Address Line 2
Ste. A3
jolene@steelheadcom.com 360-829-1330
Building RCE-13190 2/21/2020 35,000.00$
Permit Information
Please enter in the following format: 00-00000
19-00081 ID6 Ricks-Verizon
344 W 4th St., Rexburg, ID, 83440
Acceptance
Sign 5/2/2019