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h� "���SIDEWALK CAFt APPLICATION <br />CitY of South Bend - Board of Public Works <br />227 W. Jefferson BOulevard, Ste.13:16 <br />_ South Bend, IN 46601 <br />RESTAURANTIBUSINESS INFORMATION: <br />Fatbird <br />Name of Restaurant/Business: <br />103 W Colfax Ave <br />Address of Proposed Sidewalk Cafe: <br />103 W Colfax Avo South Bond, IN 46601 <br />Mailing Address: <br />I APPLICANT INFORMATION: I <br />Austin Cabello <br />Applicant Legal Name: <br />Title: IR Owner ❑ Manager ❑ Other <br />austin@hauntofhounds.com <br />Email Address: <br />5745140803 <br />Phone, <br />I INCLUDETHE FOLLOWING ITEMS WITH YOUR APPLICATION: J <br />❑ Completed application including $10fee. Make checks payable to City of South Bend. <br />❑ Site 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 fora sidewalk <br />cafe as permitted herein. I do hereby certify and affirm that all the information given in this <br />application is true to Jthof my k vledge. <br />Signature of Applicant:e s Date: <br />OFFICE USE ONLY: <br />Date Received: Fee Paid: Approval Date: <br />