HomeMy WebLinkAboutWORK ACCEPTANCE FORM EDSTROM CONSTRUCTION - 21-00048 - City of Rexburg - Barney Dairy Lift Station - ElectricalContractor 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
Edstrom Construction
Bryce Dalton
City
Rexburg
State / Province / Region
ID
Postal / Zip Code
83440
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
1305 South 12th West
Address Line 2
bryce@edstromconstruction.net 2083563577
Building PWC-C-10467 5/31/2021 $
Permit Information
Please enter in the following format: 00-00000
21-00048 Barney Dairy Lift Station
Barney Dairy Road behind junior high baseball field
Acceptance
Sign 1/21/2021