Public Works Engineering Manager
R. Neal Howard, P.E.
Public Works Superintendent
Theodore H. Lawson
Public Works Assistant Superintendent
Richard H. Crist, P.L.S.
Inspection Services Director
Thomas J. Waters, CFM
Inspections Engineering Manager
Matthew Barclift, P.E., CFM
Facilities Engineering Manager
Tyler Martin, P.E.
Building Maintenance Superintendent
George E. Oaks
Director, Public Safety Communications
Eric M. Linsley
MOBILE COUNTY PUBLIC WORKS
Inspection Services ∙ 1110 Schillinger Rd North ∙ Mobile, Alabama 36608
Phone: (251) 574-3507 ∙ Fax: (251) 574-3509 ∙ www.mobilecountypublicworks.net
CREDIT/DEBIT CARD INFORMATION
Name on Card: ________________________________________________________________________
Credit or debit card?: _________ Type (circle one): VISA MASTERCARD DISCOVER
Account Number: ______________________________________________________________________
Expiration Date: _____________________________ Security Code: __________________________
Billing Address: _______________________________________________________________________
City, State, Zip: _______________________________________________________________________
Personal/Business Address (if different): ___________________________________________________
_____________________________________________________________________________________
Contact Number: ______________________________________________________________________
Fax Number: _________________________________________________________________________
Email Address: ________________________________________________________________________
By signing this document you authorize Mobile County, Alabama to debit/charge such card for the
cost of permit(s) plus transaction/processing fee(s).
If an individual, signed by:
________________________________________ Date: ___________________________
(Must be same name as on card)
If a company, signed by:
________________________________________ Date: ___________________________
(Signature)
________________________________________ ________________________________
(Printed Name) (Title)
click to sign
signature
click to edit
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