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/�11TIf Bp1 , 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 />__ IHl3 <br />RESTAURANT/BUSINESS INFORMATION: <br />Name of Restaurant/Business <br />'5Cat \2-\--roD <br />Address of Proposed Sidewalk Cafe: L d' E- �7 F��u- r — -9I J i-> <br />Mailing Address: /0�-- e- ('?W >. <br />APPLICANT INFORMATION: <br />Applicant Legal Name: �� ��ft��J S ��' �� Phone: <br />Title: Owner ❑ Manager ❑ Other <br />Email Address: -kTr0- i�dv!}CLIZ� oS�iT�}c.� rZvuP, Co^ <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 attorney€ees,which <br />the City may suffer or incur as the result of any us the si s for a sidewalk <br />cafe as permitted herein. I do hereby certi it a in or n given in this <br />application is true to the best of m <br />Signature of Applicant: � Date: SS-' 01 - 2-3 <br />OFFICE USE ONLY" - t�(po <br />Date Received: a�� Fee Paid: Approval Date: <br />'k -�- <br />