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New
Renewal
Individual
Corporation
LLC
Body Art - Tattoo
Body Art - Piercing
Body Art - Ear Piercing Only
Class A - Beauty Salon (with nails)
Class A - Nail Salon
Class B - Barbershop
Class B - Beauty Salon (without nails)
Class B - Tanning Salon
Electronic Smoking Device
Portable Chemical Toilet - Construction Site
Portable Chemical Toilet - Temporary Event
Temp. Trailer
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
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AK
AZ
AR
CA
CO
CT
DE
FL
HI
ID
IL
IA
KS
KY
ME
MD
MA
MI
MN
MS
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MT
NE
NV
NH
NJ
NM
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OH
OK
OR
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RI
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AS
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FM
GU
MH
MP
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PR
VI
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
Add Officer(s)
Add Practitioner
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.
Add Manufacturer
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)
Pay Now
Submit & Pay Later
Type Full Name :
Sign With Hand
Clear
Done
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
Name
State
City
Title
Address
Phone #
Email
ZIP
Officer
Save
Cancel
City
ZIP
State
Material
Name
Manufacturer
Address
Save
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Pending
Approved
Denied
Address 2
Date of Birth
Practitioner
City
State
Certificate #
Cell Phone #
Address
Home Phone #
Name
Email
ZIP
Save
Cancel
Your application has been submitted successfully.
Reference Number:
Date Submitted:
Business Name:
Fee:
Confirmation email sent to:
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Find My License
Business Address
To locate last year's Health Licensing application, provide atleast 2 of the following information.
Once you are finished, press Find My License, from there, you can update any information for the renewal application.
Business Name
Business Owner Last Name
Renew your Application
Business Owner Email