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SIDEWALK CAFE APPLICATION <br />G, City of South Bend - Board of Public Works <br />227 W. Jefferson Boulevard, Ste.1316 <br />South Bend, IN 46601 <br />RESTAURANT/BUSINESS INFORMATION: <br />Name of Restaurant/Business: <br />�p <br />Address of Proposed Sidewalk Cafe: %901- V�t;.. , 1 9,, � <br />Mailing Address: r f <br />APPLICANT INFORMATION: <br />� 1 � So C% 10- <br />Applicant Legal Name: � f� 'r�0 fC Phone: <br />Title: ,Owner ❑ Manager ❑ Other <br />Email Address: 3�P—A- (&) dkt U" <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />W-c"ompleted application including $10 fee. Make checks payable to City of South Bend. <br />.015ite plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />.Completed Agreement <br />.Certificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City <br />of South Bend as additional insured) <br />AFFIRMATION <br />I, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the <br />South Bend Municipal Code and with all the provisions stated above as conditions of the <br />issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of <br />South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which <br />the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk <br />cafe as permitted herein. I do hereby certify and a it that all the information given in this <br />application is true to the bit o� knpyvledge. i <br />Signature of Applicant: \ ! Date: <br />OFFICE USE ONLY: `", <br />Date Received: Fee Ndi �00 Approval Date: <br />4-i2-' 7 <br />