License - Renewal for Public Parking Facility - 100 W. Navarre St., 621 Memorial Dr., 707 N. Michigan St.

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For all municipal business license questions, contact: City of South Bend -Department of Community Investment 227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY MUNICIPAL CODE SECTION - 4-39 I. APPLICATION TYPE Check One: New Renewal $5.00 Public Portal II. BUSINESS DATA A. Business Name: MEMORIAL HOSPITAL OF SOUTH BEND / BEACON HEALTH SYSTEM B. Business Address: 100 W NAVARRE ST / NAVARRE PARKING GARAGE City: SOUTH BEND State: IN Zip: 46601 C. Mailing Address (If different from above): 615 N. MICHIGAN ST. - PROPERTIES DEPT. City: SOUTH BEND State: IN Zip: 46601 D. Business Telephone Number: 574-647-1471 E. Business Fax Number: 574-647-1473 F. E-Mail Address: PLEDA@BEACONHEALTHSYSTEM.ORG G. Maximum Number of Vehicles that can be parked at facility at onetime: 591 H. Total Number of Parking Spaces at facility: 591 I. Hours during which vehicles may be stored: 7 DAYS / 24 HOURS H. Premises are (check one): Leased by Applicant Owned by Applicant X If Leased: Owner's Name: Owner's Business Address: City: Owner's Residential Address: ate: Zip: City: State: Zip: J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: THE HORTON GROUP (ATTACHED) For Office Use Only Application Filed JANUARY 6, 2023 Public Works Approval Application Fee Paid JANUARY 6, 2023 License Fee Paid Sent to Dept. License Number PBP2023-001 CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS Not Approved WA4 Reason Elizabeth A. Maradik, President Gary A. Gilm, Member pe. y A Murray L. Miller, Member M/ Joseph R. Molnar, Vice President JordanV. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: February 14, 2023 BALANCE DUE - $80,00 Continue to page 2