HomeMy WebLinkAboutHOILMAN ELECTRIC CO INTERNET ACCESS.TIF04/07/2009 10:10
8288741396 HOILMAN ELECTRIC CO PAGE 01
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CATAWBA COUNTY
BUILDING SERVICES
PERMIT CENTER P.O. Box 389
Newton, NC 28858
Fax Number (828) 468.8982 Newton Orflce
Fax Number (820) 322-6814 Hickory offim
UMCS Phone Number (828) 465 -6399
Contractor Informatio for Internet Access
If applicant holds multiple licenses, a separate application must be submitted for each license.
ALL FIELDS MIDST BE COMPLETED OR THE APPLICA770M tMLL BE REJECTED
Company name as listed on state license: 1 Mkw r yMC
License holders name as listed on State License: L _ 1 r Q „i
(If different from Company Name) (First Name) (M) (Last Name)
License Number. 8 3 5 4 - LA- _ License Expiration Date: 1- 731 1
Address- 4 Zq iy\ a ,,r 5
Z-8 to
E -mail address: Qc-o Q 4_hNxir r 1Jt4- r,/4AL I' oM
(E -mail addresses will be used for notification)
Telephone: Z - _ ,So
Fax Number: _$ - "i y _ 8 q t,
Mobile Cell: 8 - 4q- Li l 6
Name(s) of any other Qualifier listed on the license:
Name(s) of any other person that is authorized to sign for a permit with Catawba County:
Signature of applica ""�_�1.r.. �5� _ Dat
By signing this a w - Icatl on, you agree to maintain the Becurily 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 are listed on as a contractor. Your User name and temporary password will be sent to the
email address you provided obeve after the information on this form is verified.
This form can be mailed to the address or either of the tax numbers listed above.
120/2009