HomeMy WebLinkAboutKylie Rhymer App 610265 07 12 23 ENVIRONMENTAL HEALTH
Catawba County Government Center
catawba county 25 Government Drive I P.U. Box 389 I Newton, NC 28658
public health Phone: (828)465.8270 I Fax: (828) 465.8276
MAIM.LIVICI. .
Email: EHAdmin@CatuwboCountyNC.gov
Application for Tattooing Permit
ID )Di(6 le co)"
Dote of Application (0/ 25
T.rfi#nn Artist frifotmation: lam,_
First Name ltiy itei Last Name -1'IyYY'>Cf MI f`"
Mailing Address: 52 l,,,p4 S� CA I
City .� C -f State 1J c: Zip 2 6(a(3
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Telephone Number: 2 B 30 - (4,SW+ E-mail: 4.t f?C to C rer"( 1 t�rn cut .['Qrn
Tattoo Establishment Information:
Name of Establishment: `n Arrheyi be -Ll cI sO
Street Address: lO�J l L. \ ckke9Q Pwe.`
City y 1�'1 `` State TJC Zip 2B(o%
Business Hours: --C-Qe5 S CrA cken — ram fV)
Number of Tattoo Artists in Estabil meat 5 Anticipated Date to Begin Tattooing: er ale,..-b.-1
Tattoo Artist Signature: S6J �4�1
Instructions
Purpose: To allow tattoo artists to apply for tattooing permits a s required in General Statute 130A-283 and ISA NCAC 18A.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 lull 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. Tire 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 1 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)
4'A CATAWBA COUNTY
+ G 100A SOUTHWEST BLVD
a a NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Wednesday, July 12, 2023
$4 2 SM www_catawbacountync.gov
PAYOR: Curtis&Co Spa
Curtis&Co Spa(Gutierrez,Dawn)
PAYMENTS
TRANSACTION NUMBER: TRC-68361834-12-07-2023
PAYMENT DATE: 07/12/2023
PAYMENT TYPE: Cash
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-23-425306 110-580200-663000 Tattoo Artist Fee S225.00
TOTAL PAYMENTS: SS225.00
FLI-05-2019-115494
CASE TYPE: Food&Lodging Institutions WORK CLASS: 61 -Tattoo Artists
SITE ADDRESS: 105 N COLLEGE AVE,NEWTON NC 28658
Applicant KYLIE RHYMER,905 5TH ST NE,CONOVER NC 28613
C:8283026884 KYLIERHYMER@GMAIL.COM
Paid By CURTIS&CO SPA, 105 N COLLEGE AVE,NEWTON NC 28658
C:8282385739 DAWNMARIENAYLOR@GMAIL.COM
*'NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 07/12/2023 10:08 Page 1 of 1