Sidewalk Cafe - Nom Nom Pho Asian Kitchen

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APPLICATION FOR SIDEWALK CAF]k PERMIT CITY OF SOUTH BEND, INDIANA DATE 07/30/2018 Applicant's Legal Name Devi Raman Sapkota Title Business Name I..Sapkota Brothers LLC dba Nom Norn Pho Asian Kitchen Address 211 N Main Street Telephone Number 574 — 404 - 6480 Proposed Location and Description of Sidewalk C66 In front of building to the north side of entrance at 211 N Main street Owner Days of Sidewalk CalI6 Operation Hours of Sidewalk Caf6 Operation Sun Mon Ties Wed Thurs Fri Sat 11:30am- 8pm CLOSED I I am- 9pm Ilam- ...9prn 11 am- 9pm Ham- lopm I I am - 9:30pm The following information is REQUIRED for completion of a Sidewalk Caf6 Application: 1. Completed/signed application, including a $10.00 fee 2. Drawing(s) and description of proposed sidewalk caf6 showing p➢acementldimensions of proposed cafd 3, Completed/signed Agreement 4. Certificate of Insurance ($1,000,000/occurance and $300,000/person, naming the City of South Bend as additional insured) AFFIRMATION 1, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the South Bend Municipal Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk cafd as permitted herein. I do hereby certify and affirm that a l the inrfion given in this application is true to the best of my knowledge. 07/30/2018 = 1'_� Date Signature of Applicant Devi Raman Sapkota Printed Name Owner Title BOARD OF PUBLIC WORKS APPROVAL President Nlkmber Member fA 2 Member Member Date' RETURN FORM TO: 4 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 * Fax: (574) 235-9171