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Planning and Development Services 2001 S. State Street N3-600 • Salt Lake City, UT 84190-4050 Phone: (385) 468-6700 • Fax: (385) 468-6674 Millcreek.Utah.gov Utility Connection Agreement I, the undersigned, hereby request that the following utility connection(s) be made to/ for a building or structure herein described, for the purpose of construction. I understand and agree that the structure described herein will not be occupied nor used for any purpose of construction thereof, authorized by a valid building permit, and pursuant to Salt Lake County Ordinance 15.08.015. Use and/or occupancy shall not be permitted until all approvals from all departments have been granted, and the final inspection has been approved and/or a certificate of occupancy issued. I agree that no connection to any utility shall be made pursuant to Salt Lake County Ordinance 15.16.030. I further understand and agree that the failure to comply with any part of this agreement, by myself, or those in my charge, may result in the following action(s) to be taken against me by Salt Lake County in order to obtain compliance herein: 1. Preclude any approval of utility connections related to any other active permits held by me 2. Notify the State of Utah Division of Occupational of Professional License to appropriate action against my license. 3. Take legal action against me personally pursuant to Salt Lake County Ordinances 4. Request that all utility connection be removed by the utility company. I furthermore agree to hold harmless Salt Lake County and the utility company for any loss, damages and claims arising from the enforcement of this agreement. Individual Name: Driver’s License # State Phone # Contractor Name: Contractor’s License Phone # Permit # Address Lot # Gas Electrical I understand and agree to all provision contained herein and referenced thereto. Responsible Party State of Utah ) : ss County of Salt Lake) On this day of 20 personally appeared before me, who acknowledged that he/she signed the above certificate and that the statements contained therein are true. Notary Public _ My Commission Expires _ Residing in I furthermore agree to hold harmless Salt Lake County and the utility company for any loss, damages and claims arising from the enforcement of this agreement. YOU MUST CALL ROCKY MOUNTAIN POWER & LIGHT 1-[PHONE REDACTED] AFTER COMPLETING THIS FORM. IT IS UP TO YOU TO REQUEST POWER AND GET A WORK ORDER NUMBER. 5.16.030 Utility Connections It is unlawful for any person, firm, corporation or utility company to energize, supply fuel, or provide service to any structure, building service equipment and/or wiring, gas metering equipment, piping and/or appliances for which a building permit is required, until approval is granted by the building official. The building official may order utility services terminated at any location where the use is not authorized. Bf6 JAN 6 17