HomeMy WebLinkAboutCUSTOM PLBG INTERNET ACCESS APPL.TIFMar 28 2009 1:44PM Custom Plumbing 8283222014 p.1
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CATAW BA COUNTY P.O. Box 369
Newts^ NC 29659
BUILDING SERVICES fox Number IRS) 465.8962Ne~Offee
PERMIT CENTER ea: Number 1828) 312.6814 Hltkoryotflte
on OMke Phe Number (8161465.8399
Contractor Information for Internet access
If applicant holds multiple licenses, a separate application must be submitted foreach license.
ALL FIELDS MUST BE COMPLETED OR THE APPLICATION WILL BE REJECTED
Company name as listed on state license: dds - ly n ?hUA i.ne ii� 4 7F nd _ZA'�
License holders name as listed on State License: L Y 62 a/)
(If dlfferentfrom Company name) irst Name] (M) (Last Name)
License Number: 0th. 6 /_5" Llc. Expiration Date: AA - .3 / - 0200
Address: /ra, j, 'na ', P n . ZAX / 69 _
U - 1, _ . • , M ►1 e i e
V l�'or /YC agbea
E -mall address: SarrJreLU &5A' om C±))6fmrt31 • Cpm
(E -mail addresses will be used for notification)
Telephone: Sag' J agA - /& 0 7 3
Fax Number: gag- 392'2 —a0 /i/
Moblle Cell-
Names) of any other Quallfler listed on the license: 01L d 4 +/'1 L Bai ly
Narne(s) of any other person that is authorized to sign for a permit with Catawba County:
7e res a _ T
Slgnature of applicant: � Zel Date: A —A7- ado °f
By signing this application, you agree to maintain the security of the log -in name and password.
Password security will be the Nil responsibility of the applicant.
The Issuance of a log -In and password wlll allow a person to schedule Inspections for all projects they
are listed on as a contractor. Your User name and temporary password will be stmt 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.
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