APPLICATION FOR TATTOOING PERMIT

A $225.00 fee is required with each completed application

1. Date of Application:
2. Tattoo Artist Information:
Name: First	Last	MI
Home Mailing Address:
City:	State:	Zip:
Telephone Number: home	cell:
Email Address:
3. Tattoo Establishment Information:
Name of Establishment:
Street Address:
Business Hours:
Number of Tattoo Artist in Establishment:
4. Anticipated Date to Begin Tattooing:
5. Tattoo Artist Signature:

INSTRUCTIONS

Purpose: To allow tattoo artist to apply for tattooing permits as required in General Statutes 130A-283 and 15A NCAC 18A .3202. A separate application must be completed for each permit. Preparation: Each tattoo artist must compete and sign a separate application for each location where he or she will engage in tattooing within the State of North Carolina. The completed application must include the full name, mailing address and signature of the tattoo artist, the name and street of the tattoo establishment, and the anticipated date of commencing operation. Submission: The completed application must be submitted to the local health department in the county where the tattoo establishment is located at least 30 days before commencement of operation. The local health department may require payment of fees or additional information upon submission of the application. Disposition: This form may be destroyed in accordance with standard 8.B.6, of the Records Disposition Schedule published by the N. C. Division of Archives and History.

APPLICATION AND PAYMENT CAN BE SUBMITTED IN PERSON OR BY MAIL TO:

Cleveland County Permits Office

1333 Fallston Road

Shelby, NC 28150

*** Please call 980-484-4779 to arrange for submission and payment of fees***

Rev. 12/23