Temporary Body Art Establishment Permit Application

Temporary Body Art Establishment Permit Application
• Applying 10 days or more in advance of the event ensures this application will be reviewed.
• Each booth location requires its own permit.
• Applications will not be processed until payment has been received.
• Fees are not refundable, and permits are not transferable.
• Violations that may result in immediate closure include but are not limited to:
o Eating, drinking, or tobacco/niccotine products in the body art area;
o Use of alcohol, drugs, or other intoxicating substances;
o Lack of a hand washing station or having unsanitary conditions.

Business Name
Applicant Name

First NameLast Name
Person in Charge (If Different from Applicant)

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Event Name
From

MonthDayYear
Date
To

MonthDayYear
Date
Start & End Times
Event Street Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Location Name

TattooPermanent MakeupBody Piercing
Reusable equipment requiring sterilizationSingle-use disposable equipment
If you plan to use reusable equipment, how will you sterilize the equipment?
Body Art OperatorEvent Organizer
Body Art OperatorEvent Organizer

Fee: $100 per event and a 50% late fee if operating without a permit.

Temporary Body Art Establishment Permit

$100.00 Quantity

Total

$0.00

Credit Card

Signature

Clear
Should be Empty: