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HomeMy WebLinkAboutFLI-08-2022-178866.tif IMVDROGECEMYad NEadmm Catawba County Government Center catawba county 25 Government Drive P.O. Box 389 I Newton, NC 28658 Phone:(828) 465-8270 I Fox: (828) 465-8276 F /7$661° Application for Tattooing Permit ID 20,16,)Q3�7 Date of Application First Name De3lsi Last Nome 7A4t MI J Mailing Address: S 7 I N• MARS 10•1 LIVE (moo J R APT I O Q City vNi t 1"(*. State Zip 21 1 0 Telephone NumberC3142:0 3. 1CeC3 E-mail: Name of Establishment: "l"A'tT P --ro ©f— tit ud Street Address: Sr ► `r � City 14(.4—Ko114i State N G Zip Business.Hours: 4‘1Noe N t orK Number of Tattoo Artists in Establishment �L Anticipated Date to Begin Tattooing: Tattoo Artist Signature: Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 130A-283 and ISA 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. DER 4015(Revised 11/00) Environmental Health Service Section(Review 11/03) C, CATAWBA COUNTY E l)i3 CA 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 V 'y� Monday,August 29,2022 .18 , Z SM www.catawbacountync.gov PAYOR: Tattoo Factory Tattoo Factory(Aviles,Donald) PAYMENTS TRANSACTION NUMBER: TRC-46225393-29-08-2022 PAYMENT DATE: 08/29/2022 PAYMENT TYPE: Cash INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 08-22-411257 110-580200-663000 Tattoo Artist Fee $225.00 TOTAL PAYMENTS: $225.00 FLI-08-2022-178866 CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists SITE ADDRESS: 724 1ST AVE SW,HICKORY NC 28602 Applicant TATTOO FACTORY,724 1ST AVE SW,HICKORY NC 28602 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 08/29/2022 14:16 Page 1 of 1