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For all munidpaI 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 - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One <br />II. BUSINESS DATA <br />New Renewal X <br />A. Business Name: SUMMER SPA MASSAGE <br />B. Business Address: 3601 E. JEFFERSON bLVD. <br />City. SOUTH BEND State: IN ZPp, 46615 <br />C. Mailing Address (If different from above): <br />city: <br />D. Business Telephone Number: 574-383-5035 <br />E. Business Fax Number: <br />F. E-Mail Address: 1726065950@QQ.COM <br />Zip: <br />G. Zoning of Business Location: NEIGHBORHOOD CENTER <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 the suspension/revocation: <br />I. Describe the nature and scope of the business: PROVIDE THERAPEUTIC MASSAGE <br />For Office Use Only <br />Application Filed <br />FEB 1 6 2024 <br />Public Safety Approval <br />Application Fee Paid <br />License Fee Paid <br />FEB 4 <br />Sent to Dept. <br />F E8 1 9 ZUZ4 <br />License Number <br />,��`7�.._' <br />� <br />5�'Lr <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Not Approved <br />yy <br />/Z V' <br />Reason <br />Elizabeth A. Maradik, President <br />Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member <br />Breana N. Micou, Member <br />Murray L. Miller, Member Attest: Laura D. Hensley, Acting Clerk <br />Date: March 26, 2024 <br />