Tooele Health Department
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Application for Body Art Establishment Permit
Please put N/A for any fields that are not applicable
Establishment Name
Organization Name:
City: State/Province: ZIP/Postal Code:

Name of Business Owner
Phone Number
Street Address
Mailing Address (invoice/correspondence)
Applicant is
If partnership, list name and address of each partner
If you have additional documents to send, please email them to
Is this for a Mobile Body Art Establishment?
If yes, please email with dates and locations of each event. Pictures of the space used for the events must also be emailed.

Applicant agrees that maintenance of a health permit is predicated on compliance with the
Tooele County Health Regulations for Body Art Facilities.
This permit is revocable for non-compliance.
Permit is valid for one year from date of issue.

Applicant's Signature

BODY ART ESTABLISHMENT PERMIT (Annual):   $100.00   Select:   Item Subtotal:  
MOBILE BODY ART ESTABLISHMENT PERMIT(Annual):   $100.00   Select:   Item Subtotal:  
Temporary Event Permit (per day/per event):   $15.00   Quantity:   Item Subtotal:  
Late Fee If Applicable:   $   Item Subtotal:  
'Please Select Method of Payment to Continue'
Payment Information:
Method of Payment:
  Credit/Debit Card
 Update Name from Above
Name on Account:
Routing Number:
Account Number:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
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