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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: 574.235.90 1 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA <br />A. Business I <br />B. Business d <br />City <br />C. Mailing Address (If different from above): <br />City: <br />D. Business Telephone Number: <br />E. Business Fax Number: Yt U F. E-Mail Address: "ana ra l 10D'6 Qti nit � <br />Zip: <br />G. Zoning of Business Location: <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municip lity within three (3) years prior to the date of this application: <br />YES NO <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation following the suspension/revocation: <br />I. Describe the nature and scope of the business: � �wo_ ;j <br />r - ., - <br />For Office Use Only <br />Application Filed FEB ® 7 2024 Public Safety Approval <br />Application Fee Paid FEB 0 7 2024 License Fee Paid <br />Sent to Dept._Fio 0 7 2024 License Number I'�`� '• - . <br />Feb. 8, 2024 sent copies of app to SBPD & SBFD <br />Not Approved <br />CITY OF SOUTH BEND, IND[ANA <br />Reason BOARD OF PUBLIC WORKS <br />tla(�k ",�Zm <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />%YGwy A yn-A�-' <br />Joseph R. Molnar, Vice President <br />Breana N. Micou, Member <br />Murray L. Miller, Member <br />Attest: Laura D. Hensley, Acting Clerk <br />Date: March 26, 2024 <br />