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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 • 574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />1. APPLICATION TYPE <br />II. BUSINESS DATA <br />New owner for an already existing massage establishment. <br />Check One: New Renewal <br />A. Business Name: <br />B. Business Address: <br />City: '' tt.i ,, 701't n1 <br />C. Mailing Address (If different from above): <br />City: <br />D. Business Telephone Number: <br />E. Business Fax Numb r: _f <br />F F-Mail Aririrpre, 11_� I W <br />State: ! Zip: <br />_State: _ Zip: <br />3 91t l— <br />�, <br />G. Zoning of Business Location: L:AnLy-%m E..f o iti f% <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 />J. Include a list of massage therapist employed at this location: (include a separate sheet if necessary) <br />'\f,..: �.".� \ <br />For Office Use Only <br />Application Filed J AN 0 4 2023 Public Safety Approval <br />Application Fee Paid—JAN 0 4 707.1 License Fee Paid JAN <br />Sent to Dept. J�nN 4 4 2023 License Number <br />,t rJAN � 1�Q?,� Z,c�►1i,Za ._,�A�vQ_.2.2023_ <br />Not Approved ✓(-; i2,&1 1 1 2n2 v0"'i+ ea, -A .�J AN 12 2023� <br />Reason CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />tilta <br />Elizabeth A. Maradik, President <br />�-•� Qs� :tom <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: February 28, 2023 <br />