HomeMy WebLinkAboutWORK ACCEPTANCE FORM TILSON TECHNOLOGY MANAGEMENT - 21-00186 - T-Mobile Cell Tower - Antenna ModificationContractor 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
Tilson
Thomas Price
City
Portland
State / Province / Region
ME
Postal / Zip Code
04101
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
16 Middle St 4th Floor
Address Line 2
tprice@tilsontech.com 801-668-9528
Building RCE - 51178 4/30/2023 $
Permit Information
Please enter in the following format: 00-00000
21-00186 Brigham Young University - Idaha
BYU Idaho Stadium, 525, Rexburg, ID 83460
Acceptance
Sign 5/25/2022