HomeMy WebLinkAboutFLI-08-2022-177722.TIF ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 ( Newton, NC 28658
public health Phone: (828) 465-8270 I fax: (828)465-8276
.*II114.urn!. .
Email: EHAdmin@CotawbaCountyNC.Gov
Ft 1 " 0S ' X)) .f77))
n Application for Tattooing Permit
i
Date of Application .Q I c Z2 I () c)V ) V I V 3 J S
ai:too Artist information:
Fuss Name Cti-i- Y1 Le.. last Name (�T11-{.Yl Mtb
,Ylig Address` 1Ot 38-�' l -ANL lJ E-
C* J
Gko h-\ slide ivc, zip 2S 10.0
Taiping Nam: 431 2 - 45 s (o4Vc E-. pd k- I h eri-,,yu, l.cot,,
6 2Tattoo Establishment Information: Cm Li- �' 4 b 7e' ��'1' �h--f
m
Nor of : 61kArilt (b Pox
streetAdeass: 22 1kmon Sq
ar L�Cn r� State [. rip 2g lI) 01
Business Hours: °A+ryn- 1O p ry
Number of Tattoo Arists in fsfri'■ed Amilrlded Date to Begin Tunes
Tattoo Artist Signature: "Pia
Instruction
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 130A•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
sigoatere of the tattoo artist, the name and street address of the tattoo estatishment,and the aulrdgded date of
commencing operatim.
Submission: The completed application must be submitted to the local health deportment 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
oddiBerai irfarwatiou rpm Admission of the apprrostion.
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.
DOB 4115(Revised 11/00)
EaWrsoweatd Haab Service SeaYoa(Review 11/03)
�Y'A • C ATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 INVOICE/RECEIPT
4 ( PHONE:828.465.8399
J Monday,August 15, 2022
www.catawbacountync.gov
Invoice Number: 08-22-4 1 053 1 Invoice Date: 08/15/2022
FL1-08-2022-1 77722
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 228 UNION SQUARE A,FIICKORY NC 28601
Applicant BLUME BEAUTY BAR, 1021 38TH AV NE,HICKORY NC 28601
PDK_I5 a HOTMAIL.COM
Paid By BLUME BEAUTY BAR,PO BOX 705,HICKORY NC 28601
B:8284469793 ALLYTHARPE 1 @GMAI1..COM
**NO PEOPLESOFI ACCOUNT ASSIGNED**
PAYOR: Blume Beauty Bar
Blume Beauty Baar(Huffman,Allison)
FEES
FLI-08-2022-177722 FEE AMT DUE AMT
Tattoo Artist Fee 110-580200-663000 08/15/2022 S225.00 $0.00
FEES: $225.00 $0.00
TOTAL FEES: $225.00 $0.00
PAYMENTS
INVOICE NUMBER FEE NAME FEE AMOUNT
TRANSACTION NUMBER: `I'RC-45336735-15-08-2022
PAYMENT DATE: 08/15/2022
PAYMENT TYPE: Credit Card
293785881
08-22-410531 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: S225.00
invoicereceipt 08/15/2022 09:29 Page 1 of 1