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)us iness license questions, contact: City of South Bend - Department of Community Investment <br />fferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235.9021 <br />=NSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />I. APPLICATION TYPE Check One <br />New Renewal $5.00 Public Portal <br />II. BUSINESS DATA <br />A. Business Name: MEMORIAL HOSPITAL OF SOUTH BEND / BEACON HEALTH SYSTEM <br />B. Business Address: 621 MEMORIAL DR / LAFAYETTE PARKING GARAGE <br />City: SOUTH BEND State: IN Zip: 46601 <br />C. Mailing Address (If different from above): 615 N. MICHIGAN ST. - PROPERTIES DEPT. <br />City: SOUTH BEND _ ,State: IN Zip: 46601 <br />D. Business Telephone Number: 574-647-1471 <br />E. Business Fax Number: 574-647-1473 <br />F. E-Mail Address: PLEDA@BEACONHEALTHSYSTEM.ORG <br />G. Maximum Number of Vehicles that can be parked at facility at onetime: 599 <br />H. Total Number of Parking Spaces at facility: 599 <br />I. Hours during which vehicles may be stored: 7 DAYS / 24 HOURS <br />H. Premises are (check one): Leased by Applicant Owned by Applicant X <br />If Leased: <br />Owner's Name: <br />Owner's Business Address: <br />City: State: Zip: <br />Owner's Residential Address: <br />City: State: Zip: <br />J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: <br />THE HORTON GROUP (ATTACHED) <br />For Office Use Only BALANCE DUE - $80.00 <br />Application Filed JANUARY 6, 2023 Public Works Approval _ <br />Application Fee Paid JANUARY 6, 2023 License Fee Paid <br />Sent to Dept. License Number PBP2023-003 <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />jw�4 11/,;_1(a <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member <br />772 vy C <br />Murray L. Miller, Member <br />Jordan V. Gathers, Member <br />l�14 <br />Attest: Theresa M. Heffner, Clerk <br />Date: Febmary 14, 2023 <br />Continue to page 2 <br />