Laserfiche WebLink
For all municipal business license questions, contact: City of South Bend -Department of Community investment <br />227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.591joF:574.235.9pa'a � in <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: <br />II. BUSINESS DATA <br />A. Business Name: <br />B. Business Address: �J <br />City: i! <br />New X Renewal <br />14, <br />i <br />C e <br />C. Mailing Address (If different fro above): _ <br />City: /[, y�s�L tlState: 'dtu Zip: <br />D. Business Telephone Number: <br />E. Business Fax Number: <br />F. E-Mail Address: <br />G. Zoning of Busin <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 <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: <br />For Office Use Only <br />Application Filed AUG 2 2 2022 Public Safety Approval <br />Application Fee Paid AUG z 2 2022 License Fee Paid <br />Sent to Dept. License Number Via' 01 Z <br />pb1; C-e— �AUG 2 3' 2022 FeRe <br />Not Approved _ CITY OF SOUTH BEND, IN DIANA <br />BOARD OF PUBLIC WORKS <br />Reason <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />7,z—r K 7 <br />L. <br />11/1z'M <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />�4 <br />Attest: Theresa M. Heffner, Clerk <br />Date: November 22, 2022 <br />A <br />I C) <br />