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For all municipal business license questlons, contact: Clty of South Bend - Department of Community Investment <br />227 West Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.235.5912 - F: 574.235,9021 <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />1. APPLICATION TYPE Check One: New Renewal �! <br />II. BUSINESS DATA <br />A. Business Name: S M A 9T W K T:Nt <br />B. Business Address: 133 Nl: 1" 1 a.J h 5._� a 4+ 1-0- <br />City: Vl 1 0" State: 1:N zip: y 41 ZR <br />C. Mailing Address (If different from above): PO. )3 Ox q 33" <br />City: State: ] �-� Zip: L C <br />_ ---� <br />D. Business Telephone Number: 6 ~5 %— '9) 62 <br />E. Business Fax Number: <br />F. E-Mail Address: S M C-(17LRA-Y' It 'M _ qA4 cLi 1 c o M <br />G. Maximum Number of Vehicles that can be parked at facility at onetime: 6 <br />H. Total Number of Parking Spaces at facility: <br />I. Hours during which vehicles may be stored: i�ia i Z a-/"1 /`'l%�•��r� <br />H. Premises are (check one): Leased by Applicant Owned by Applicant <br />If Leased: <br />Owner's Name: 0 61, 1?, )(2 ✓i c•7 rC.9 11 11 Ike - <br />Owner's Business Address: -2- D 1 la'V. G o l4i� A V'�e_ <br />City: 5C) Iti4-� G eli <br />Owner's Residential Address: <br />T N Zip: y_._6_d_Qu <br />City: State: Zip: <br />J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: <br />2 N1 i L [t o v lr <br />For Office Use Only <br />Application Filed MAY 1 0 2023 Public Works Approval <br />Application Fee Paid MAY 1 0 2023 _ License Fee Paid MAY 1 0 2023 <br />Sent to Dept. License Number P 1 - F f6Q QQaaI - CQ- 7 <br />OW - P�bPaQS3- Oo7 <br />CITY OF SOUTH BEND, INDIANA <br />Not Approved _ BOARD OF PUBLIC WORKS <br />Reason VIL(4 <br />Elizabeth A. Maradik, President <br />Joseph R. Molnar, Vice President <br />Q <br />61,91, <br />Gary A. Gilot, Member <br />Jordan V. Gathers, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: July 25, 2023 <br />Continue to page 2 <br />