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For all municipal business license questions, contact: City 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 />I. APPLICATION TYPE Check One: New Renewal X - NO PAYMENT <br />II. BUSINESS DATA <br />A. Business Name: MEMORIAL HOSPITAL OF SOUTH BEND / BEACON HEALTH SYSTEM <br />B. Business Address: 621 MEMORIAL DR. / LAFAYETTE PARKING GARAGE <br />City: SOUTH BEND State: IN Zip: 46601 <br />C. Mailing Address (If different from above): 615 N. MICHIGAN ST. - PROPERTIES DEPT. <br />City: SOUTH BEND State: IN Zip: 46601 <br />D. Business Telephone Number: 574-647-1471 <br />E. Business Fax Number: 574-647-1473 <br />F. E-Mail Address: PLEDA@BEACONHEALTHSYSTEM.ORG <br />G. Maximum Number of Vehicles that can be parked at facility at onetime: 599 <br />H. Total Number of Parking Spaces at facility: 599 <br />I. Hours during which vehicles may be stored: 7 DAYS / 24 HOURS <br />H. Premises are (check one): Leased by Applicant Owned by Applicant X <br />If Leased: <br />Owner's Name: <br />Owner's Business Address: <br />City: <br />Owner's Residential Address: <br />City: <br />te: Zip: <br />State: Zip: <br />J. Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: <br />BALANCE DUE - $85.00 <br />For Office Use Only <br />Application Filed JANUARY 8, 2024 Public Works Approval <br />Application Fee Paid License Fee Paid <br />Sent to Dept. JANUARY 9, 2024 License Number PBP2024-004 <br />Not Approved <br />Reason <br />1 <br />