HomeMy WebLinkAboutWORK ACCEPTANCE FORM FYBERCOM LLC - 23-00141 - 520 E Moody Rd - Cell Tower RelocationContractor 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
Fybercom LLC
Vince Calkins
City
Idaho Falls
State / Province / Region
ID
Postal / Zip Code
83401
Country
USA
Update new contact information that is not already on file with the City of Rexburg
Street Address
3780 N Yellowstone hwy
Address Line 2
vince@fybercom.net 208-521-8360
Building 036307-C-4 11/1/2023 10,000.00$
Permit Information
Please enter in the following format: 00-00000
23-00141 North Valleywide
520 E Moody Rd, Rexburg
Acceptance
Sign 4/3/2023