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2. Date of Application
   Date of Application
6. Tattoo Artist Information
8. Name
10. Mailing Address
12. City
14. State
16. Zip Code
18. Phone Number
22. Tattoo Establishment Information
24. Name of Establishment
26. Street Address
28. Business Hours
30. Number of Tattoo Artists in Establishment
34. Anticipated Date to Begin Tattooing
    Anticipated Date to Begin Tattooing
38. Establishment Plans
    Upload drawing of Tattoo booth
40. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
42. Tattoo Artist Electronic Signature*
46. Instructions
48. Purpose
    To allow tattoo artists 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.
50. Preparation
    Each tattoo artist must complete 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.
52. 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.
54. Disposition
    This form may be destroyed in accordance with Standard 8.B.6, of the "Records Disposition Schedule" published by the North Carolina Division of Archives and History. Additional forms may be ordered from: Environmental Health Section, 1632 Mail Service Center, Raleigh, NC 27699-1632 (Courier 52-01-00).
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56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field