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For all munid pal business license questions, contact: City of South Bend -Department of CommunityInvestment <br />227 West Jefferson Blvd •Sulte 1400 S -South Bend, Indiana 46601 - 574.235.5912 - r: 574.235.9021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT C'-t: S 10, <br />MUNICIPAL CODE SECTION -4-35 <br />I. APPLICATION TYPE Check One: New Renewal k/1 <br />II, BUSINESS DATA U -tom 1 <br />A. Business Name: D 1�I PDF'l9._0.aSMe l , <br />R. Business Address: 9bi '� • CO )C VQ_J ���7 <br />City: SO W+(A- E State: i V4 zip: 4 (e_ lR[7 <br />C. Mailing Address (If different from above): <br />City: State: Zip: <br />D. Business Telephone Number: J-i'� 2200— <br />E. Business Fax Number: <br />F. E-Mail Address: <br />G. Zoning of Business Location: <br />A . <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municipality within three (3) years prior to the date of this application: <br />YES NO X- <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation following thesuspension/revocatiom <br />I. Describe the nature and scope of the business: T nyl akgApit -�C- <br />For Office Use Only <br />Application Filed FEB 2 6 2024 Public Safety Approval <br />Application Fee Pair,[ F�_ 6_2024 License Fee Paid <br />Sent to Dept. License Number M S E_;1Q %4 -0Q7 <br />Aj.- A40106S <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />-aa, a <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />4 7_1&__1 <br />Murray L. Miller, Member <br />�P1 <br />Joseph R. Molnar, Vice President <br />Breana N. Micou, Member <br />Attest: Laura D. Hensley, Acting Clerk <br />Date: March 26, 2024 <br />