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For all municipal business license questions, contact: City of South Bend -Department of Community Investment <br />227 West Jefferson Blvd - Suite 14005 -South Bend, Indiana 46601 ® 574.235.5912 - F:574.235.9021 <br />'Re (,, NO . S-7 (P 024 !�$ WE <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35, <br />I. APPLICATION TYPE Check One <br />BUSINESS DATA <br />New— X Renewal <br />A. Business Name: 'S MV-7 i AA(:;E AMD 14iUaLl�)a <br />B. Business Address: N, \NktL,�)—E , -L D L+ <br />City: �u �M_4 2UV13'1D State: —Zip:: [-(- coc) I <br />C. Mailing Address (If different from above): 14 C_OTTAC-�_E cw_ov�_-- A V� <br />City: 'Qw'"�b State: v's —zip: 4WL'1Ise <br />D. Business Telephone Number: C) C) <br />E. Business Fax Number: F. E-Mail Address: �awrct @ m xEc,,ffle . ED f" <br />G. Zoning of Business Location: M <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: <br />For Office Use Only <br />Application Filed JAN 0 42018 Public Safety Approval <br />Application Fee Paid JAN 0 4 2918 License Fee Paid --- jAN 0 4 2018 <br />Sent to Dept. JAN 0 4 2013 License Number IT,03 e <br />Not Approved <br />Reason <br />A11),U0,ktjWD <br />13ymrd of p1lblic T <br />0,4 8 <br />