HomeMy WebLinkAboutWORK ACCEPTANCE FORM LEATHAM CONSTRUCTION - 23-00766 - Crapo 3 Plex - RemodelContractor 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
Leatham Construction Inc
Brian K Leatham
City
Shelley
State / Province / Region
ID
Postal / Zip Code
83274
Country
United States
Update new contact information that is not already on file with the City of Rexburg
Street Address
1316 E 1165 N
Address Line 2
Leathamconstruction@gmail.com 2083904035
2083904035
Building RCE-4737 1/17/2024 275,000.00$
Permit Information
Please enter in the following format: 00-00000
12-34567 Crapo apartments
156 East 2nd South
Acceptance
Sign 10/24/2023