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For all municipal business I loense questions, contact; City of South Bend - Department of Community Investment <br />227 West Jefferson Blvd -Suite 1400S -South Bend, Indiana 46601 -574.235,5912 - F:5�4,235.9021 0 <br />Rkc' QQ. 5 1 � qW") 1-1 1 <br />MUNICIPAL CODE SECTION - 4-35 <br />1, APPLICATION TYPE Check One: New X Renewal <br />[I. BUSINESS DATA <br />A. Business Name: South Bend Massage & Healing <br />B. Business Address: 115 N. William St. _ <br />city: South Bend State: IN -Zip: 46601 <br />C. Mailing Address (If different from above): <br />City: State: <br />D. Business Telephone Number. 574-261 -8500 <br />E. Business Fax Number: <br />F. E-Mail Address: info@southbendmassage.com <br />zo <br />G. Zoning of Business Location: MU -Mixed Use (See Attached) <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: Perform therapeutic massage services: <br />includes relaxation massage, hot stone massage, deep tissue & medical massage, <br />prenatal massage, and reflexology, all of which"I am licensed for in the state of Indiana, <br />City of South Bend, and St. Joseph County. <br />Application Filed JAN 9, 9 2018 ­ Public Safety Approval <br />Application Fee Paid jAl lo License Fee Paid JAN 29 2018 <br />Sent toDept. . _JANI 9-)III 8- License Number -.--- <br />Not Approved <br />A I" P 4 0.,V Up <br />Board Of 13111b1k, <br />Reason <br />M A D rr4n <br />0 <br />