HomeMy WebLinkAboutWORK ACCEPTANCE FORM CITY OF REXBURG - 21-00375 - Teton Lakes Golf Course - DeckContractor 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
City of Rexburg
Alex Owens
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
alex.owens@rexburg.org 208-716-1330
Electrical 054302 7/31/2022 3,800.00$
Permit Information
Please enter in the following format: 00-00000
21-00375 Teton Lakes Golf Course - Deck
722 N 12th W
Acceptance
Sign 7/6/2022