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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 - R 574.235'9021 <br />R <br />t-ec" �fv. ",?M'c)o <br />LICENSE APPLICATION FOR — MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION — 4-35 <br />I. APPLICATION TYPE Check One: <br />11. BUSINESS DATA <br />V M-1 j <br />A. Business Name: SOUTHSID'E MASSAGE RETREAT <br />B. Business Address: 411 E. lRELAND RD. SUITE 300 <br />City: SOUTH BEND <br />C. Mailing Address (If different from above): <br />City: <br />D'. Business Telephone Number: 574-8'5'5-1836 <br />State: IN <br />State: <br />E. Business Fax Number: <br />F. E-Mail Address. SMRETREAT@HOTMAIL.COM <br />G. Zoning of Business Location.. CB <br />Renewal XXX <br />Zip: 46,614 <br />Zip: <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing muniO, litywithin 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 />OPAI. Describe the nature and scope of the business: akXV-Q, <br />For Office Use Only <br />Application Filed FEB 2 6 2018 Public Safety Approval <br />Application Fee Paid FEB 2 6 Z018 License Fee Paid I-- E,13 2 6 20 18 <br />Sent to Dept. EER_2_6_?0j License Number _IjL/-0:2g <br />I a - <br />T; 'JGIs <br />Not Approved <br />Reason <br />1. <br />