HomeMy WebLinkAboutCOOK BUILDERS, JOHNNIE--INTERNET APPLIC.TIF�c CATAWBA COUNTY PO 0,,389
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Contractor Information for Internet access
If applicant holds multiple licenses, a separate application must he submitted for each license.
ALL FI EMS MUST BE COMPUTED OR THE APPLICATION J WILL BE REJECTED
Company name as listed on state license: ( [. ilD O!S
License holders name as listed on State License: )Dhr\�: _ I_ Ok
(If different from Company name) (First Name) M (Last Name) a
License Number /9 1 Lic. Expiration Date:
Address: 1F5�� Q� 201 d
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Email address: F114e(�
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(E mail addresses will be used for notification(
Telephone: g6} � — A 3N —L- Iq 2 9
Fax Number:
Mobile Cell: �
Names) of any other Qualifier listed on the license:
Names) of any other person that Is authonzed to sign for a permit with Catawba County:
Signature of applicant 44 Date
By signing this applicatio,yo agreeto maintainth security of the log- in name and password.
Password security will be the full responsibility of the applicant.
The issuance of a log -in and password will allow a person to schedule inspections for all projects they
a re listed on as a contractor. Your User name and temporary password will be sent to the email
address you provided above after the information on this form is verified. This form can be mailed to
the address or either of the fax numbers listed above.