Fill and Sign the Notice of Commencement Utah State Construction Registry Form

Notice of Commencement - Utah State Construction Registry30 E. Broadway Suite 300Salt Lake City, UT 84111(801) 983-0275 or (877) 9UT-EGOVFAX: (800) 585-1534 SCR User Name or Account # Building Permit # or Project ID: Building Permit/Project ID Not Applicable Issuing Municipality: Not Applicable Original Contractor Name/DBA Name: Original Contractor Address: Original Contractor Telephone: Project Type: Commercial Residential Name and Address of Project Owner: Name and Address of Surety Providing Payment Bond: Payment bond is not required for work being performed Project Address: Project Information Name and General Description of the Project (Include lot or parcel number, subdivision, development, or other project name): Filer Type: Owner of construction project Original contractor Filer Telephone: Fax: Filer Filer Name and Address: Same as Original Contractor Listed Above Email: I prefer not to receive notices concerning this filing. List the email address, postal address, or fax number of up to three persons to receive notifications concerning this project:Email 1: Email 2:Email 3: Notification Email Notification (No Charge) Address/Fax Notification ($6.00 processing fee per address)Address/Fax ($6.00) Address/Fax ($6.00) Address/Fax ($6.00) Payment Processing Fee $15.00 ___ Addresses X$6.00 + Total Fees: Check Enclosed – Check # (make checks payable to Utah Interactive) Bill my Credit Card # Expiration Date: / I have an account on file with the SCR – please bill me.NOTE: If you do not have a credit accountwith the State Construction Registryprogram, you must include payment ofcheck or credit card. Failure to providepayment will result in this notice beingreturned as not filed.NOTICE: Terms and Conditions – Processing fees are due at the time of filing. The processing fee for offline filing of a Notice of Commencement is$15.00. All fees associated with the State Construction Registry are posted at the SCR web site: http://scr.utah.gov. Fees are non-refundable. Filings willbe deemed “filed” when the designated agent receives a complete form and valid payment. Incomplete filings will be returned as not filed andcorrections will be subject to an additional processing fee. The individual or entity filing this form assumes all liability for the completeness andaccuracy of the form, and for it being “filed” within the time limits specified in Utah state law. Neither the state of Utah, the SCR, nor its designatedagent is responsible for lost, late, or misdirected mail. The state of Utah, the SCR, and its designated agent specifically disclaim any liability for thetimeliness and accuracy of any filings, including alternate filings submitted according to offline methods (for example, but not limited to, telefax andmail submissions). Complete terms and conditions are available at http://scr.utah.gov.Signature:Title: Date: