HomeMy WebLinkAboutCONTRACTOR INTERNET ACCESS--CUSTOM PLM.TIF,5� 3 &- o7
CATAWBA COUNTY
BUILDING SERVICES
PERMIT CENTER
P.O. Box 389
Newton, NC 28658
Fax Number (828) 465962 Newton Office
Fax Number (828) 322 -6814 Hidcory Office
Office Phone Number(828) 465 -8399
Contra 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: G IGS - A,
License holders name as listed on State License: s eVG
(If different from Company Name) (First Name) (M) (Last Name)
License Number: /&6 / License Expiration Date:
Address: /4* jr- l��Gd�IK d/.,,( ' 4 A 990
�Q s1`nia, iVG Zr'osSr
E -mail address: ScG r r s GGa 7�o Off 1/a A" 6 ik co Co •«
(E -mail addresses will be used for notification)
Telephone: 7o Y— 82'7 - 03 G >,
Fax Number ' °x +-827 - 78b$" -
Mobile Cell: 7 ° 67W -64 Y3
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 applicant:
Date: 3— y a
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 Iog4n 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
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