HomeMy WebLinkAboutFLI-06-2022-172937.tif catawba county
public health
AUTHORIZATION OF REFUND
Date: 6/14/22
Case #: FLI-06-2022-172937
Applicant: Alisa Bolick/ Forever Inked LLC
Refund Amount: $225
Refund Reason: artist will not be working at establishment
Authorizing Signature:
Received By Staff: 4i,/4 10k-
Date: (0 14- 22
catawbacountync.gov
Environmental Health
Cctowbo County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
Catawba County, North Carolina - Disbursement Voucher
Vendor No. Date: 6/14/2022
Make Payment To: ��Acp Voucher No(s)
Alisa Bolick 41111[46Forever Inked LLC ��� y
1630 N Center St v a ��� �'
Hickory, NC 28601 184.2
ATTACHMENT
Prepared by: Julia English
Description Amount
Artist will not be working at establishment $225.00
Sub-Total
Food Tax
Sales Tax
Total $ 225.00
For Accounting Use
Fund Cost Center Object Project Amount Only
110 580200 663000
Total
The undersigned hereby certifies that the goods or services specified above have been received
or performed. Payment has not been previously authorized and this expenditure is a proper
charge to the appropriation indicated. The above charge is certified to you for payment.
(SIGNATURE-APPROPRIATE OFFICIAL)
$A CO� CATAWBA
100A COUNTY
SOUTHWESTO
NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Tuesday,June 14, 2022
18 4 sM www.catawbacountync.gov
PAYOR: Forever Inked LLC
Forever Inked LLC(Bolick,Alisa)
PAYMENTS
TRANSACTION NUMBER: TRC-4 1650840-14-06-2022
PAYMENT DATE: 06/14/2022
PAYMENT TYPE: Credit Card
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
06-22-407368 110.580200-663000 Tattoo Artist Fee ($225.00)
TOTAL PAYMENTS: (S225.00)
FL1-06-2022-1 72937
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 1630 N CENTER ST,HICKORY NC 28601
Applicant SEAN HOMMEL, 1523 CRANBERRY LN,SANFORD NC 27330
C:9197465350 OFF-BEAT7i@YAHOO.COM
Paid By FOREVER INKED LLC, 1630 N CENTER ST,HICKORY NC 28601
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 06/14/2022 14:01 Page 1 of 1
ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba County 25 Government Drive I P.O. Box 389 I Newton, NC 28658
Phone: (828) 465-8270 I Fax: (828) 465-8276
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Application for Tattooing Permit
Date of Application : '1\1\ ( ), ;�� �l DL�, " 7''
Tattoo Artist Informat10 L.
First Name 40 ,M M L MI t Last Name r \A/
Mailing Address: k 4 ►1% C R fL /+ (, , kit—
City e A ��FOR Z P State Zip 2 7. >e
Telephone Number: S`J 5 Email: (f 1"F- 6 E!t r ? 1 C'1AFNdo 'CO "t^
Tattoo Establishment Information.
f,
Name of Establishment .��CE
Street Address: L(S) fl c(r'
City '‘c \'Q( (�1`\ State QC Zip O oO
Business Hours: \ \ r(S)
Q \
Number of Tattoo Artists in Establishment ' W k '' icipated Date to Begin Tattooing: "JwhQ...
Tattoo Artist Signature:--)0. 1 1/
Inc In ctio"
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 1 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
`�' 100A SOUTHWEST BLVD
+ � NEWTON,NOR"FI I CAROI,INA 28658 RECEIPT
C..) PHONE:828.465.8399
Monday,June 6,2022
18 2 SM www.catawbacountync,gov
PAYOR: Forever Inked LLC
Forever Inked LLC(Bolick,Alisa)
PAYMENTS
TRANSACTION NUMBER: TRC-41183804-06-06-2022
PAYMENT DATE: 06/06/2022
PAYMENT TYPE: Credit Card
290918706
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
06-22-407368 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-06-2022-172937
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 1630 N CENTER ST, HICKORY NC 28601
Applicant SEAN 11OMMEL, 1523 CRANBERRY LN,SANFORD NC 27330
C:9197465350 OFF-BEAT7I r YAIIOO.COM
Paid By FOREVER INKED LLC, 1630 N CENTER ST,HICKORY NC 28601
**NO PEOPLESOFTACCOUNTASSIGNED**
receipt 06/06/2022 13:20 Page 1 of 1