HomeMy WebLinkAboutWORK ACCEPTANCE FORM TETON REPAIR LLC - 21-00595 - 611 Johnson St - AdditionContractor 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
Teton Repair LLC
Shawn Derrick
City
Sugar City
State / Province / Region
Idaho
Postal / Zip Code
83448
Country
Madison
Update new contact information that is not already on file with the City of Rexburg
Street Address
430 E. Palomino Dr.
Address Line 2
tetonrepair19@gmail.com 480-580-6181
480-580-6181
Building RCE-51963 7/15/2023 $
Permit Information
Please enter in the following format: 00-00000
21-00595 Jim Croasmun
611 Johnson st. Rexburg ID 83440
Acceptance
Sign 10/13/2022