HomeMy WebLinkAboutCONTRACTOR INTERNET--LAKE NORMAN CUSTOM DOCK.TIFCATAW BA COUNTY P.O. Box 389
G Newton, NC 28658
(¢ t f % BUILDING SERVICES Fax Number (828) 465 -8962 Newton Office
v �c PERMIT CENTER Fax Number (828) 322 -6814 Hickory Office
j842 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 OR THE APPLICATION WILL BE REJECTED
Company name as listed on state license: �. -►� fJ ��M C s'T a"'�� ►�
License holders name as listed on State License: — O f.&-1'J E
(If different from Company name) (First Name) (M)
License Number: A F P L i Ei] T ° iZ Lic. Expiration Date:
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(Last Name)
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Address: IJ, C)
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E -mail address: U L � moo« C k
(E -mail addresses will be used for notification)
Telephone: b y g e 3 Z/ V 9
Fax Number: 066 57 y5.39
Mobile Cell: 7 U L l Co 3 y y Z 53
Name(s) of any other Qualifier listed on the license: N 6^J 1=
Name(s) of any other person that is authorized to sign for a permit with Catawba County:
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Signature of applicant:. T '� \'°— — —�?f e �.' Date: Z Z j Z DG
By signing this application, you agree to maintain the 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
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.
12/18/2007