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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 5 -South Bend, Indiana 46601 • 574.235.5922 • F: 574,235.9021 <br />fC.73 �c <br />R�1'7C <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT MO <br />MUNICIPAL CODE SECTION -4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />IL BUSINESS DATA <br />A. Business Name: <br />B. Business Addres <br />City: .��i l � ui State: ] dip: <br />C. Mailing Address (If differentfrorn above): <br />City: State: Zip: <br />D. Business Telephone Number: <br />E. Business Fax Number: <br />F. E-Mail Address: <br />G. Zoning of Business Locat///Jion: GY NCal `I <br />H. Have you ever had a Msage Establishm t license, or similar license, suspended or revoked <br />by any governing munici lit within three (31 years prior to the date of this a ppIication: <br />YES NO <br />1. If yes, what was the reason: <br />Z. If yes, what was the business occupation following the suspensionfrevocation: <br />I. Describe the nature and scope of the bursi-ness: 1 �'II& nrS j y V Mfo� <br />( <br />For Office Use Only <br />Application Filed FEB 2 8 20Z3 Public Safety Approval <br />Application Fee Paid 7-023 License Fee Paid FEB 2 <br />2023 <br />Sent to Dept.License Number <br />Po1i 0- FFIRE Zoni rL� <br />Not Approved _CITY OF SOUTH BEND, INDIANA <br />Reason BOARD OF PUBLIC WORKS <br />VA�a <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />'15�zra <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />r*)4 <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: April 25, 2023 <br />