HomeMy WebLinkAboutCATAWBA COUNTY SCHOOLS INTERNET ACCESS FORM.TIFCATAWBACOUNTY Paaarus
Nero, NC 22659
BUILDING SERVICES Fn N1MsNI9221aa6a9@NbsAw0
PERMIT CENTER Eu %mmr mauaz -sue HNrmy oma
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arse Prom Number (BIB) 4669"
Contractor Information for Internet access
N applicant holds multiple licenses, a separate application must be submitted for each lime .
ALL FIELDS MUST BE COMPLETED OR THE APPLICATION WILL BE REJECTED
Company name as listed an state license: Ck4•nWbw iilounA 5sLea6
License holders name as listed on State License: 1 4Ne L W ,llren.a
(If different from Company name) (First Name) (M) ILast Name)
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License Number: Lla Expiration Date:
Address Pe Bas. /DIe
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E-mail address: ' ° nc _
(E -mail addresses will be used for notification)
Telephone.
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Fax Number:
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Mobile Cell:
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01347
Names) of any other Qualifier listed
Name(s) of arty other person that b authorized to sign for a permit with Catawba County:
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rAp 14ur. after
Signature of applicant " 6 •C'U— Date: ° -3 0 5
By signing this application, you agree to maintain the security of the login 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 lived on as a contractor. Your User name and temporary password will be sent to the email
address you provided absence after Ube infomnadon on this form is verified. This form can be mailed to
the address or either of the fax numbers listed atone.
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