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For a I I 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: 574,235.9021 <br />r), <br />K62KO, 990 166 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: <br />II. BUSINESS DATA <br />lm <br />A. Business Name: CHINESE MASSAGE SPA <br />B. Business Address: 2614 S, MICHIGAN ST. <br />City: SOUTH BEND <br />C. Mailing Address (if different from above): <br />City: <br />D. Business Telephone Number: 574-514-0242 <br />E, Business Fax Number: <br />State: IN <br />State: <br />Renewal XXX <br />Zip: 46614 <br />Zip: <br />G. Zoning of Business Location: MIXED USE <br />H. Have you ever had a Massage Establishment l'icense, 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 />e the nature and scope of the business: W 0 � i Jk <br />'row 1C-A <br />4- A0 'I <br />For Office Use Only <br />Application Filed FEB 2 7 2018 Public Safety Approval <br />_R 2-7— FEB 2 7 2018 <br />Application Fee PaidT —2018 License Fee Paid <br />Sent to Dept. FEB 17 2.018 License Number <br />61UX(I Of <br />Not Approved <br />Reason <br />I <br />W <br />