Fill and Sign the Preliminary Notice Utah State Construction Registry Scr Form

Notice of Completion - 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 # This Notice is filed for State Construction Registry Project #: Note: A valid SCR Project #, Building Permit #, or Project ID # is required Building Permit # or Project ID: Building Permit/Project ID Not Applicable Issuing Municipality: Not Applicable Project Address: Original Contractor Name/DBA Name: Project Type: Commercial Residential Original Contractor Telephone: Specify how eligibility for final completion was determined: Project Information Permanent Certificate of Occupancy was issued by the local government entity having jurisdiction over the construction project. Final Inspection of the construction project complete – no Certificate of Occupancy required. Determination that no substantial work remains to be completed – Neither a Certificate of Occupancy nor Final Inspection is required. Filer Type: Owner of construction project Original contractor Surety Lender Filer Telephone: Fax: Filer InformationFiler Name and Address: Same as listed under SCR Account ID Specified Above Email: Payment Processing Fee $15.00 Check Enclosed – Check # (make checks payable to Utah Interactive) Bill my Visa Mastercard Card # Expiration Date: / I have an account on file 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 ofcheck 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. All fees associated with the State Construction Registry are posted at the SCR web site: http://scr.utah.gov. 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). Complete terms and conditions are available at http://scr.utah.gov. Signature:Title: Date: