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SIDEWALK CAFE APPLICATiON <br />CIOV �Ii SOLIt11 C-cind - C-001-C QP P iblic b�e•ri�� <br />'_'' �V.1er`�r�:n E��l�v.tl L. �Cc..I�• I. <br />= South rid. IN ���� i <br />C- <br />REST URANTMU`INESS INFQRN1ATIQN: <br />1i1f!il Qr Rest.]Uf:1rCr F1.�11�i:SS; Cainty i IJa FV��u} E +J ` Tho 01,, okl3;t �� uL '-Zo lt1 Utn tk_ <br />^':t N I�IiCRi�;�t1 St Sout16 �-tt0, 1N -IQ&"It <br />,address of Fr-QLvsi2L SidcwaIk CJ�e': �-- _. <br />2043 sCuth Send Aw 19:.So �h Fc�nv• iN I '0'. <br />APPLICANT INFL1RKATION: <br />Applicant legal Name. Tht S-m6tast Ciuo Suuu� t;om!. LL1. Phe�ne: Or 7 Y5 155 O8I`)�, <br />Title: a 0tivner CQ ht.;nagcr Q Other <br />Email Addre-�: austin OLE hauntofhounds.com <br />! INCLUDE THE FOLLOWNG ITEMS WITH YOUR APPLICATION: <br />ISN-ompletcd application including $ 10 fee, Make checks p�iyable to City cat South Benv. <br />Q Site plan depicting the proposed sidewalk cafe showing placeni ntldimensionS. <br />[!�Completcd Agreement <br />❑ Ccrtiilcate of Insurance (31,000,000, occurrrnte and S3Qt.).C)0Q Lerst?n namil►j; the C itV <br />of South Gcnd as additional Insured? <br />AFFIRMATION <br />I. the undersigned, agree that I will abide by all of the provisions 0 Section IS-1S kit they <br />South Bend Municipal Code and with ill the provisions statcel abcivc ,t� conditions of th;' <br />issuance of this Permit. I further agree to hidemnify, d0end and hold h wrrtllcss the Cit. of <br />South Bend From any liability, loss. cost. darnaCze or expenses, locluding attorney fee-, 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 of firm th�it till the information give+t itt thi: <br />application is true to thCbe of my K�iowfed�r. <br />Signature of Applies t - Date*: --- -- —.__ <br />OFFICE USE ONt_ Y- <br />Oste Received: Fce Paid. t14vprV01 Ootc: <br />