HomeMy WebLinkAboutYen Bui VBeauty LLC 610302 app 04 14 23 18‘
11 ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba county 25 Government Drive I P.O. Box 389 I Newton, NC 28658
public health Phone: (828) 465 8210 Fax: (828) 465-8276
.`��� nr,u. Email: EHAdmin@CntawbaCountyNC.gov
Application for Tattooing Permit n _
Dale of Application / 2 I Z 3
Tattoo Artist Information:
First Name 7 e N last Name '5 U x MI
Mailing Address:
City H1c 0 R.. State N C- Zip 7, ' Cn 0 2---
Telephone Number: Q y ' 9 �3 ` 7 E-mail: V t a .) 73 01 i,f/ l /t.TN,
Tattoo Establishment Information:
Name of Establishment: V [3 C.ct t(-f;-c.tJJ LI a
Street Address: Z.0 2— .S IOC 12,—+ 1'1 vJ y
City c.v.( State1Zip ZF-(.0o 1—
Business Hours: 5 cr_4 el,ft/ D ni x
Number of Tattoo Artists in Establishment Anticipated Date to Begin Tattooing:
I.
Tattoo Artist Signature: /--'
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute J 30A-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
t include the iull name,
ress and
sgnwithin t thee State
tattoo North
arti artist, name completed
streetapplication
address of the tattoo establishment,and he'anticipated date of
signature o
commencing operation.
l
Submission: The completed applicationsbeforeust 6commert commencement of the
operatohealth
Thedepartment
local health department where
may requiretpayment establishment
of fees or
located at least 30 days
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.
DENR 4015(Revised 11/00)
Environmental Health Service Section(Review 11/03)
CATAWBA COUNTY
IW 100A SOUTHWEST BLVD
NEWTON,I IORTH CAROLINA 28658 RECEIPT
v / PI TONE:828.465.8399
Friday,April 14,2023
1842 5M www.catawbacountync.gov
PAYOR: VBeauty LLC
VBeauty LLC(Bui,Yen)
PAYMENTS
TRANSACTION NUMBER: TRC-61851615-14-04-2023
PAYMENT DATE: 04/14/2023
PAYMENT TYPE: Credit Card
303770901
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
04-23-421252 110-580200-663000 Tattoo Artist Fee $225.00
TOTAL PAYMENTS: $225.00
FL1-04-2021-148935
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 3202 S NC 127 HWY,HICKORY NC 28602
Applicant VBEAUTY LLC,3202 S NC 127 HWY,HICKORY NC 28602
B:7044317788
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt
04/14/2023 L1:33 Page 1 of l