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For all municipal business license questions; contact: City of South Bend • Department of Community Investment �1 <br />227 West Jefferson Blvd • Suite 1400S -South Bend, Indiana 46601. 574.235,5912 • F: 574. 1.902 4(t5g�o <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA <br />A. Business Name: L L E <br />B. Business Address• <br />City: <br />C. Mailing Address (If different from,above): <br />City; II \\ State: Zip: <br />D. Business Telephone Number: (-SLU- J C510 _ mn\- \ <br />E. Business Fax Number: <br />F. E-Mail Address: -\7\kU XV! aQA �17L11 �el�li�c �aMAdL Cam) <br />G. Zoning of Business Location: <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/' <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: M�I�E `b9 cam— 1 �15 <br />QNQUZ�Y ��- AePs4�0a�t1c <br />1aP�ssPtc� t �.o, �c, SKI r� c N(?' ,�yocnk c-uA-t's'<I>, Xo <br />aoo.w <br />For Office Use Only <br />Application Filed FED 2 12017 Public pproval <br />Application Fee PLicense Fee Paid <br />Sent to Dept. FEB 2 12011 License Number, 17-7650 <br />AVPAQVE6) <br />39strdl of Pukak Work" <br />Not Approved <br />Reason 10.9 14 7011 <br />