Laserfiche WebLink
w <br />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 •574.235,51312 • F: 5�4.23S.9021 <br />r�� <br />� LJ(_ �Oq <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT r <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA <br />A. Business Name: V 1 <br />B. Business Address: HM IF- CA&�' sk- NO <br />City: 4A_V_14� T� State: (� Zip: t <br />C. Mailing Address (If different from above): 32Z .� o �,�t kGt�( jll� Acgo <br />City: raaKtt'- State: (1y Zip: !t tolet-1 <br />D. Business Teleph <br />E. Business Fax Nu <br />F. E-Mail Address: <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 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: 1 gffT�Y <br />J. Include a list of massage therapist employed at this location: (include a separate sheet if necessary) <br />For Office Use Only <br />F E E. 0 1202 3 <br />Application Filed 9 Public Safety Approval <br />Application Fee Paid FEB U t 2021 License Fee Paid <br />Sent to Dept. k 1: R i) 1 7II7'1 License Number. /05E� UX3 — 00c"&_. <br />of i CL __R?C _ —rl ; re — rnF �� 0 2 2023 _J-j ec,14 _ /3-? /a3 <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />tji�(4 <br />Elizabeth A. Maradik, President <br />3�-� Gfs�i .tom <br />Gary A. Gilot, Member <br />pt_" J, 9 � <br />mm­y L. rvuu comc� <br />1,10-2P1 <br />Joseph R. Molnar, Vice President <br />Jordan V. Gathers, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: May 23, 2023 <br />