The URL can be used to link to this page

Home My WebLink AboutTobias Agurrie 610349 app 09 21 22 N.C. Dpartment of Environment and Natural Resources Division of Environmental Health APPLICATION FOR TATTOOING PERMIT pp 09/21/2022 FL! .L}�. �p)) .J 61?g3I 1. Date of Application ' ! 2. Tattoo Artist Information: j V [) t,i SOIC3!j Name: First Tobias last Agurrie Mi Mailing Address: 2422 Claremont Rd City Newton State Nc Zip 28658 Telephone Number: 8283024309 E-mail: tobiasartworks828@gmail.com 3. Tattoo Establishment Information: Name of Establishment: Ink Addicts LLC Street Address: 780 4th st dr sw hickory nc 28602 Business Hours: 12-8pm Number of Tattoo Artists in Establishment 2 4. Anticipated Date to Begin Tattooing:09/23/2022 5. Tattoo Artist Signature: R/ 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) �$A • CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 Wednesday,September 21,2022 www.catawbacountync.gov PAYOR: Agurrie,Tobias PAYMENTS TRANSACTION NUMBER: TRC-4765 1 295-2 1-09-2022 PAYMENT DATE: 09/21/2022 PAYMENT TYPE: Credit Card 295331084 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 09-22-412497 110-580200-663000 Tattoo Artist Fee $225.00 TOTAL PAYMENTS: $225.00 FL1-09-2022-180837 CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists SITE ADDRESS: 780 4TH ST DR SW,I IICKORY NC 28602 Applicant TOBIAS AGURRIE,2422 CLAREMONT RD,NEWTON NC 28658 TOBIASARTWORKS828@GMAIL.COM GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 09/21/2022 14:46 Page 1 of 1