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For all rnunid pal husiness Ilcense questions, oontar_t: City of South Bend • Department of Community Investment <br />227 Wes[ Jefferson Blvd • Suite 14005 •Soutti Bend. Indiana 46601 •574.235.5912 • F: 574.235.9021 <br />CKS.3 3 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICI PAL CODE SECTION -4-35 <br />I. APPLICATION TYPE Check One: New Renewal t/ <br />If. BUSINESS DATA <br />A. Business Name: `!-lE'�P�i�li1[� �1171,LtLt.7L <br />B. Business Address: e-)02R�rJ D <br />city: �ot.� ��►-��7 <br />C. Mailing Address (If differentfrorn above): <br />City: <br />State: <br />Zip: <br />D. Business Telephone Number:{ Sid ll�e� <br />E. Business Fax Number: <br />F. E-Mail Add ress�}?tJ►ic'�.l�ula[I __. f"-.4-.Ate __a�3M <br />G. Zoning of Business Location. n6 if3OM-',4trt tr> Gf-,N +C='� <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municipal' ithin three (3) years prior to the date of thisapplication: <br />YES NO <br />Z. If yes, what was the reason: <br />2. If yes, what was the business occupation following thesuspension/revocation: <br />I. Describe the nature and scope of the business:_�3 tom:"fit <br />tf'O:.k3+� Ar rl k� i�� t� s� }.-+�.i���c[�✓V �'C�12�.Fc�� _ S�iJ�7 Cf4�� � <br />A-, �L .0 _ It'S �_t�•t P��Z_ <br />For Office Use Only <br />Application Filed FEB 1 6 20 Public Safety Approval <br />Application Fee Paid r Ets I b niq License Fee Paid <br />Sent to Dept. r �B 1 (j 2V_1I License Number GA 27 <br />Not Approved CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Reason tIU4 M <br />Elizabeth A. Maradik, President <br />�ts7J�7 <br />Gary A. Gilot, Member <br />9yg"r 4 <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />6,,; /. <br />Attest: Theresa M. Heffner, Clerk <br />Date: April 23, 2024 <br />