HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLASER CONSTRUCTION - 20-00169 425 S Harvard - Duplex Bldg 1 - Blake WillisContractor 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
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 5/31/2023 $
Permit Information
Please enter in the following format: 00-00000
20-00169 Blake Willis - Duplex
425 Harvard Ave
Acceptance
Sign 5/4/2022