HomeMy WebLinkAboutWORK ACCEPTANCE FORM KCC TECH - 21-00071 - T-Mobile Cell Tower - Parts ReplacementContractor 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
KCC TECH
Cody Thornock
City State / Province / Region
Postal / Zip Code Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
Address Line 2
Cody.thornock@kcctech.com 9518347758
Building RCE57125 2/3/2021 $
Permit Information
Please enter in the following format: 00-00000
21-00071 SL01482A
1095 East Butte RD Sugar City IDAHO ID 83434
Acceptance
Sign 3/4/2021