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For all municipal business license questions, contact. City cf south Bend • Deparfinentof Community Investment NC', i <br />227 West Jefferson Blvd • Suite 1400 5 -South Bend, Indiana 46601 0 514.235.5412 - F: 574.235{�9022Ji / I - ��)T V <br />i ] e c , 6 �ito �Ci` ! <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT 59,1�5 VD <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One <br />II. BUSINESS DATA <br />New Renewal X <br />A. Business Name: King Asian Massage <br />B. Business Address: 914 s Ironwod dr <br />cIty_5outh Bend <br />C. Mailing Address (if different from above): <br />ON Zip. 46615 <br />City: State: Zip: <br />D. Business Telephone Number: 574-855-4254 <br />E. Business Fax Number: <br />F. E-Mail Address: Jingwang0329@gmall.com <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 municipality within three t3j years prior to the date of thisapplication: <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: massage therapy <br />For Office use Only <br />Application Filed FEB 2 2 2024 Public Safety Approval <br />Application Fee Paid Q?4 License Fee Paid <br />Sent to Dept. ttti Tf, ZT License Number_ �' — 00 <br />HEAL-rq-;4olo3) 56Pb <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />JC�ri� �a <br />Elizabeth A. Maradik, President <br />�v Q� plot <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />�77t <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: April 23, 2024 <br />