Phone #
Block
Business Details
Registration Type
Address 2
Type the street number and name to select the Address
Business Name
Business Category (If Other)
Type of Ownership
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Lot
Business Category
Address
Description
Square Feet
{[PNAME]}
  • Contacts
  • Business Information
  • Body Art Establishment
  • Portable Chemical Toilets
  • Certification
Last Name
Name
Address
Email
Address
Mailing City, State, ZIP
Phone #
Emergency Contact Details
Building Owner Details
State
Phone #
Last Name
First Name
Phone #
Business Owner Details
First Name
City
Email
ZIP
Close
Tuesday
Open
Friday
Saturday
Hours of Operation (If Applicable)
Sunday
List names and addresses of all owners of this business.
Wednesday
Thursday
Monday
List names and addresses of all practitioners that operate at this business.
Autoclave Serial #
Medical Generator ID #
Autoclave Model
Ear piercing only
Tattooing/permenant Cosmetics
List names and addresses of all manufactures of processing equipment, instruments, jewelry and inks used for any and all body art procedures (tattooing and piercing)
Body and Ear piercing
(Check all that apply)
Autoclave Make
Tattoo Parlor Details (If Applicable)
End Date Toilet(s) will be on-site
# of Portable Toilets on-site
Start Date Toilet(s) will be on-site
Portable Chemical Toilet Details (If Applicable)
List of Days for Temporary Event If Not Concurrent (7-day Maximum)
Type Full Name :
Sign With Hand
I, the undersigned, agree to comply with all local, county, state and federal orders and regulations applicable to this license, and is responsible for obtaining any and all additional required approvals, permits, and licenses.
Disclaimer: Proof of Business Liability Insurance must be attached in order to process your application.
Amount Due
Fee Schedule
Certification
Attachments
Applicant Signature