Laserfiche WebLink
For all municipal business license questions, contact: city of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235,9 1 <br />&71038q <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT $-a D5'vb <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA <br />A. Business Name: <br />B. Business Addret <br />City: itb\ \!5VA,A) <br />C. Mailing Address (If different from above): <br />State: . 1 �� Zip: <br />City: State: Zip: <br />D. Business Telephone Number: <br />E. Business Fax Number: _ <br />F. E-Mail Address: my'pkz (A a �1 - C' cwy) <br />G. Zoning of Business Location: \ 4?Q w_'C6 <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municipality within three (3) years prior to the date of this application: <br />YES NO X <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation following the suspension/revocation: <br />I. Describe the nature and scope of the business: <br />For Office Use Only <br />G)oRKs <br />Application Filed FEB 15 2017 Public sefewyApproval <br />Application Fee Paid FEB 15 2017 License Fee Paid FEB 15 20174 Sent to Dept. FEB 15 2017 License Number 174d <br />APP$OVW <br />Board of Pullldc Work_, <br />NotApproved <br />Reason <br />