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For all municipal business license questions, contact: City of South Bend 9 Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 5 •South Bend, Indiana46601-574-235.5922 • F.574.235,9021 <br />-T�e.C. I 0 co 15'10 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: <br />11. BUSINESS DATA <br />New X Renewal <br />A. Business Name: Soul Fire Yoga LLC <br />B. Business Address: 2314 E. Mishawaka Ave <br />City.. South Bend State: IN Zip. 46615 <br />C. Mailing Address (If different from above): 903 Wheatly Drive <br />City. South Bend State: IN Zip; 46614 <br />D. Business Telephone Number: 5748503704 <br />E. Business Fax Number: <br />F. E-Mail Address: soulfireyogasb@gmall.com <br />G. Zoning of Business Location: <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 thisapplication: <br />YES NO X <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: Yoga Studio, Teacher led classes utizling <br />breath and movement. Heated and non -heated classes, meditation, and wellness. <br />For Office Use Only <br />OCT 4 6 7027 <br />Application Filed ublic Safety Approval <br />Application Fee Paid 7 l ieense Fee paid <br />Sent to Dept. oci A 6 IA22 License Number <br />-Fire. _�nini� <br />Not Approved J <br />Reason CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />tjA�14 1Z111_ 77Z <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />d �•y � /y r �y 1n q y^�y <br />f r r a4 C_5 40- �'�.�(�+}+ I l L1xl �' 7 1 1 'G t Gary A. Gilt, Member <br />�IfJ 4 1 1 whS Sin} +P Vi�uin� aef4 <br />Murray L. Millet' Member <br />Jordan V. Gathers, Member <br />„%/ <br />Attest: Theresa M. Heffner, Clerk <br />Date: November 22, 2022 <br />