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For all m.inici pal butlness license questions, rortart: City of South Bend ■ Department of Community Investment <br />221 West JeffefSV'1 Blvd • Suite 14005 -South Send, Indiana 46WI • 574.235.5912 • F: 574.235.902 <br />15 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT CK 114A 7 z <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One; New <br />II. BUSINESS DATA <br />A. Business Name: <br />B. Business Address: <br />%(A PI t <br />newal <br />LK to,003II3 $14i <br />ZV <br />City: S ign mind State: IN Zip: Lkokl5 <br />C. Mailing Address (If differentfrorn above): <br />City: State: ii'' rr Tip: <br />D. Business Telephone Number: 14 --� 3—,A "t`"i' <br />E. Business Fax Number: <br />F. E-Mail Address:V.1,ar� _caw-% <br />G. Zoning of Business Location: 1m1'DV)Maa umu <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 <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: <br />lOwA ShdlO,,�� <br />For Office Use Only <br />Application Filed FEB 2 9 2024 Public Safety Approve! <br />Application Fee Paid FEV, I Tmi License Fee Paid FEB 2024 <br />Sent to Dept. FEB Z t 2024 License Number MSFA0 0,L4 - C11 Q <br />Health 2401256 SBPD CITY OF SOUTH BEND, INDIANA <br />Not Approved SBFD <br />BOARD OF PUBLIC WORKS <br />� �a �� <br />Reason <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member Breana N. Micou, Member <br />Murray L. Miller, Member Attest: Laura D. Hensley, Acting Clerk <br />Date: March 26, 2024 <br />