Laserfiche WebLink
SIDEWALK CAFE APPLICATION <br />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 />Address of Proposed Sidewalk Cafe: S i V Sew -f660( <br />Mailing Address: Z o. '-Ro- l (00� - <br />1 APPLICANT INFORMATION: <br />Applicant Legal Name: <br />Title: ❑ Owner ❑ Manager Ii"Other <br />Email Address:.) <br />Phone: ��r-`i -Z�5 rAC <br />INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />❑ Completed application including $10 fee. 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 attorneyfees, 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 affirm that all the information given in this <br />application is true to the best of my knowledge. <br />Signature of Applicant: <br />Date: <br />OFFICE USE ONLY: <br />Date Received� Fee Paid: � 13�� Approval Date: <br />