HomeMy WebLinkAboutCONTRACTOR INTERNET ACCESS--WOODLIEF.TIFMar 13 09 07:13a
CATAWBA COUNTY
BUILDING SERVICES
PERMIT CENTER
p.1
P.O. Box 389
Newton, NC 28658
Fax Number (828) 465 -8962 Newton Office
Fax Number (828) 322 -6614 Hickory Office
office Phone Number (828) 465.8399
Contractor Information for Internet Access
If applicant holds multiple licenses, a separate application must be submitted for each license.
ALL FIELDS MUST BE COMPLETED O THE APPLICATION WILL BE REJECTED
Company name as listed on state license: ( Q UO LIGF L Lf6 T e - (CAL nom
License holders name as listed on State License: 3 4, ,y s tjz gbi,r L: e
(If different from Company Name) (First Name) (M) (Last Name)
License Number. _ 1 q is (b `u License Expiration Date: � C7
Address: () - r'bK_' ( L( T yr�- 3 '� C _ 2 S !o q C
E -mail address: 5 w F L Q-, L «- S-,-- a er . /t) e"
(E -mail addresses will be used for notification)
Telephone: �S j� �f y - 0 7 q3(,
Fax Number. 7 4 /
Mobile Cell: q06
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:
%Z�1.
iatur of a pplicant: _
Date: 3
By signing this application, you agree to maintain the secu of the log -in name and password.
Password security will be the full responsbillity of the applicant.
The issuance of a login 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 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.
1/20/2009