Fill and Sign the Owners Guide Utah State Construction Registry Form

Notice of Commencement - Utah State Construction Registry 30 E. Broadway Suite 300 Salt Lake City, UT 84111 (801) 983-0275 or (877) 9UT-EGOV FAX: (800) 585-1534 SCR User Name or Account #      Project Information 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:       Name and General Description of the Project (Include lot or parcel number, subdivision, development, or other project name):       Filer Filer Type: Owner of construction project Original contractor Filer Name and Address:                   Same as Original Contractor Listed Above Filer Telephone:       Fax:       Email:       Notification I prefer not to receive notices concerning this fling. List the email address, postal address, or fax number of up to three persons to receive notifcations concerning this project: Email Notifcation (No Charge) Address/Fax Notifcation ($6.00 processing fee per address) Email 1: Email 2: Email 3: 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 fle with the SCR – please bill me. NOTE: If you do not have a credit account with the State Construction Registry program, you must include payment of check or credit card. Failure to provide payment will result in this notice being returned 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 are associated with the State Construction Registry. Fees are non-refundable. Filings will be deemed “filed” when the designated agent receives a complete form and valid payment. Incomplete filings will be returned as not filed and corrections will be subject to an additional processing fee. The individual or entity filing this form assumes all liability for the completeness and accuracy 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 designated agent is responsible for lost, late, or misdirected mail. The state of Utah, the SCR, and its designated agent specifically disclaim any liability for the timeliness and accuracy of any filings, including alternate filings submitted according to offline methods (for example, but not limited to, telefax and mail submissions). Signature: Title:       Date: