HomeMy WebLinkAboutMichael French App 610208 09 14 22 N.C.Dpartment of Environment and Natural Resources
Division of Environmental Health
APPLICATION FOR TATTOOING PERMIT
1. Date of Application 9-14-2022 RI -03 -)t'17 -0' 3 J7 7
2. Tattoo Artist Information: '% )o`' u i 6 )0 8
Name: First Michael Last French Ml R
Mailing Address: 1282 Trinity Pl.
City Granite Falls state NC Zip 28630
855-4370 E-mail: mikefrenchtattoo@gmail.com
Telephone Number: 828
3. Tattoo Establishment Information:
Name of Establishment: Westside estside Tattoo Company
Street Address: 1001 A 1st. St. W, Conover, NC
Business Hours: Tues-Sat 12-6
Number of Tattoo Artists in Establishment 2
4. Anticipated Date to Begin Tattooing: 9-14-2022
5. Tattoo Artist Signature : 11/ 7L___.
. \ ;�
INSTRUCTIONS
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A-283
and 15A NCAC 1 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.
Additional forms may be ordered from Division of Environmental Health
1630 Mail Service Center
Raleigh,NC 27699-1630
(Courier 52-01-00)
DENR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
gA CATAWBA COUNTY
Q' r-°c
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658RECEIPT
V1 ,4. PHONE:828.465.8399
Wednesday, September 14,2022
1$4 2 5M www.catawbacountync.gov
PAYOR:
French,Michael
PAYMENTS
TRANSACTION NUMBER: TRC-472 11469-14-09-2022
PAYMENT DATE: 09/14/2022
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
09-22-412157 110-580200-663000 Tattoo Artist Fee ;2)5.00
TOTAL PAYMENTS: S225.00
FLI-03-20 17-083279
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 1001 1ST ST W,CONOVER NC 28613
Applicant MICHAEL FRENCH, 1282 TRINITY PL,GRANITE FALLS NC 28630
C:8288554370 MIKEFRENCHTATTOO ri GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 09/14/2022 13:56 Page 1 of 1