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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 • 574.2,35.5912 • R 574,235,9021 <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION 4-39 <br />I. APPLICATION TYPE Check One: New Renewal XXX <br />II. BUSINESS DATA <br />A. Business Name: BEACON I IEALTH SYSTEMS f MEMORIAL HOSPITAL PARKING GARAGE ZONED CBD <br />B. Business Address: 621 MEMORIAL DR.. // CENTENNIAL GARAGE <br />City:. SOUTH BEND State: IN <br />C. Mauling Address (If different from above): <br />City: State: <br />D, Business Telephone Number: 574-647-7311 <br />E. Business Fax Number: 574-647-7328' <br />F. E-Mail Address: OAK %etc\ C :vn <br />Zip: <br />G. Maximurn Number of Vehicles that can be parked at facility at one time: <br />H. Total Number of Parking Spaces at facility: <6U7 <br />I. Hours during which vehicles may be stared: 0pe <br />H. Premises are (check onie): Leased by Applicant Owned by Applicant <br />If Leased: <br />Owner's Namej�mcwla <br />Owner's Business Address: Mi c hj(2(2gL� f)" <br />City: 1 V State: )1\1 Zip: �L%c' <br />Owner's Residential Address: <br />City: State:: Zip: <br />J. Insurance Carrier and Amount of Liability Insurance OR Banding Agent and Amount of Bond: <br />For Office Use Only <br />Application Piled FEB1 12018 Public Works Approval <br />Application Fee Paid FEB1 3 2018 License Fee Paid <br />Sent to Dept. �.]�� LicenseNumber I <br />of pt;1 IT4 <br />Not Approved <br />Reason <br />11 <br />