HomeMy WebLinkAboutWORK ACCEPTANCE FORM BLACK & VEATCH - 22-00899 - 525 S 2nd E - Cell Tower UpgradesContractor 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
Black & Veatch
Richard Black
City
Gardner
State / Province / Region
NC
Postal / Zip Code
27529
Country
Update new contact information that is not already on file with the City of Rexburg
Street Address
600 N. Greenfield PKWY
Address Line 2
blackr@overlandcontracting.com 714-697-3513
714-697-3513
Building RCE-37931 8/1/2023 $
Permit Information
Please enter in the following format: 00-00000
22-00899 AT&T @ 525 S 2nd E
525 S 2nd E, Rexburg
Acceptance
Sign 12/15/2022