HomeMy WebLinkAboutSteve Poteet App 610139 05 31 22 ENVIRONMENTAL HEALTH
11177 Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health Phone: (828) 465.8270 I Fax: (828) 465.8276
MAKING.LIVING.MIER
Email: EHAdmin@CatawbaCountyNC.gov
Fti"0/1 )03— 0.310 )
Application for Tattooing Permit
—20'22 1 t )0a L i 0137
Date of Application
Tattoo Artist Information: n
First Name ST Last Name /UTEG MI
Mailing Address: 9os5 eel/od6-2 d L./ib 4/
City 610/Vat-C_ State NL Zip 2$6 i3
Telephono-Number,: f 21) e-l0 q 777/ Email: s kf/3o 6ozf�/ -�/'L4/L .GoA
Tattoo Establishment Information:
Name of Establishment: U6-,e keo
Street Address: 0 4 Cro i u -' /SC 49' Ai
City eaAia✓G—!z State VL Zip g40,
Business Hours: /2— S
Number of Tattoo Artists in Establishment 3 Anticipated Date to Begin Tattooing:
Tattoo Artist Signature:
Hnstructiolrns
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A•283 and I5A NCAC I 8A.3202. A
separate application must be completed for each permit.
Preparation: Each tattoo artist must complete and sign a separate application for each location where he or she will engage in tattooing _ __
within the State of North Carolina. The completed application must include the full name, mailing address and
signature of the tattoo artist, the name and street address of the tattoo establishment,and the anticipated date of
commencing operation.
Submission: The completed application must be submitted to the local health department in the county where the tattoo establishment is
located at least 30 days before commencement of operation. The local health department may require payment of fees or
additional information upon submission of the application.
Disposition: This form may be destroyed in accordance with Standard 7 of the Records Disposition Schedule.Published by the N.C.
Division of Archives and History.
DENR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
CATAWBA COUNTY
-14 100A SOUTHWEST BLVD RECEIPT
r
NEWTON,NORTH CAROLINA 28658
PHONE:828.465.8399
Tuesday,May 31,2022
18 2 sM www.catawbacountync.gov
PAYOR:
POTEET,STEVE
PAYMENTS
TRANSACTION NUMBER: TRC-40837600-31-05-2022
PAYMENT DATE: 05/31/2022
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
05-22-407120 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-04-2013-036462
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61-Tattoo Artists
SITE ADDRESS: 808 CONOVER BLVD W,CONOVER NC 28613
Applicant STEVE POTEET,108 W 15TH ST,NEWTON NC 28658
C:828409777I
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Establishment EVERMORE CUSTOM TATTOO&PIERCING,808 CONOVER BLVD W,CONOVER NC 28613-
receipt 05/31/2022 13:31 Page 1 of 1