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Contractor Information All information is required Project Address: Contractor Name: Contractors Address: (Include city, state, zip) Phone Number: Email Address: License number: (Must end in 5501) Please note the name, address, phone number, email address, and license number of the construction manager/general contractor, as defined in Utah Code 63G-6a-103. If the owner will be acting as the construction manager/general contractor, please note the owner’s information and submit an Owner/Builder Certification to the Millcreek Building Department. The Owner/Builder Certification can be found at millcreekut.gov. If any changes are made to the contractor on file, please notify Millcreek Building Department. Name: Date: Millcreek City Council Cheri Jackson, Mayor Silvia Catten, District 1 Thom DeSirant, District 2 Nicole Handy, District 3 Bev Uipi, District 4 Millcreek City Hall 1330 East Chambers Avenue Millcreek, Utah 84106 [PHONE REDACTED] millcreekut.gov