HomeMy WebLinkAboutIsabel Juarez INJ Beauty Makeup & Skincare 610338 app 07 05 22.tif {�9 );(I i9RON ' +LPL H,a L H
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 ��.�- I -, -�.)(4,3-N
Date of Application 10 "d3 2 o 1%lX k 33%
First Name 01/4l --C/Q1� -,. ` \ II'Last Name cj Uj1k MI
Moiling Address: U Ua as,/�1UI JVVr Q 1 \E - � . (E
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Telephone Number: R2 �TLA E-mail: �.1�\a\\6\ et lJJ
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Name of Establishment: ' t 5 '1d269614 , cY--\ CWit LkC.
Street Addreess:: 2WL 10-v) NE &A\
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Business Hours: W\ONn 'AMA \\: m—(>?:0oPn1 Wed. C\ocj\ liners' fl .0/banr\-n(.Q' teknl{-`(1a i)-ygco-
Number of Tattoo Artists in Establishment \ Anticipated Date to Begin Tattooing:
Tattoo Artist Signature:cry`„"- —' /01-ig,
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 1 30A-283 and ISA N(AC 18A.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.
RECEIVED
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.
J U L — 5 2022
DENR 4015(Revised 11/00) Environmental Health
Environmental Health Service Section (Review 11/03)
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� CATAWBA COUNTY
� � /� I00A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
4,4 rsG;.. ,� PHONE:828.465.8399
(..) @t U Tuesday,July 5,2022
\S 42 SM www.eatawbacountyne.gov
PAYOR: Pure Reflection Spa for Wellness
Pure Reflection Spa for Wellness
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PAYMENTS
TRANSACTION NUMBER: TRC-42862580-05-07-2022
PAYMENT DATE: 07/05/2022
PAYMENT TYPE: Money Order 28015629952
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-22-408708 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FLI-09-201 8-1 05655
CASE TYPE: Food& Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 915 TATE BLVD SE 174,HICKORY NC 28602
Applicant ISABEL JUAREZ, 1013 22ND ST PT NE,HICKORY NC 28601
C:828358643I
Establishment PURE REFLECTION SPA FOR WELLNESS.915 TATE BLVD SE 174,HICKORY NC 28602
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 07/05/2022 11:51 Page 1 oft