HomeMy WebLinkAboutCUSTOM PLBG INTERNET APPL - S CARRIS.TIF.� ,,a-A 5 i 67
$ CATAWBA COUNTY
F`r BUILDING SERVICES
(d PERMIT CENTER
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P.C. Box 389
Ne Mon, NC 28655
Fax Niunber (62a) 465-8962 NeMon Once
Fax Number (828) 312{814 Hickory Office
Office Phone Number (828) 465 -0399
Contractor Information for Internet Access
If applicant holds multiple licenses, a separate application must be submitted for each license.
ALL FIELDS MUST BE COMPLETED OR TNEAPPLICATION WILL BE REJECTED
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Company name as listed on state license: e -A y lC� �i4�
License holders name as listed on State License: s yeye- _ c'l ro s
(If different from Company Name) (First Name) (M) (Last Name)
License Number: r?90 / License Expiration Date:
Address:
E- mailaddress: SCG��lSG Gu {vim+ 1u�.,6i. Go -fo+�+
(E -mail addresses will be used for notification)
Telephone: 7 Y- 827 - 03 6 n
Fax Number. 7 4'- 827 -7 8D>'
Mobile Cell: - 2acl ( 6 -(.aV3
Names) 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:
Signalure of applicant: Date: ?- `/ 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 or a login and password will ailowa 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.
1208009
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