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For all municipal business license questions, contact: City of South Bend • Department of Community Investment in West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 ::/,' _ 00C-i< 06'0� • b, <br />LICENSE·APPLICATION FOR·-MASSAGE ESTABLISHMENT <br />MUNIClPAL .CODE SECTION -4-35 <br />I.AP PUCA TION TYP.E Check One:New X Renewal <br />II.BUSINESS DATA <br />A.Business Name: !/car f p lk,axt m«_s�a� 'tu1,./(11 ·-t.SJ <br />B.Business Address: d.l)Qfj Tcao L4 !ao4 C ,c.c.l:e. <br />Ci ty:<\6uH, 8ft) d State: J;,v Zip: <br />C.Mailing Address (If different from aboye): <br />City: <br />D. Business Telephone Number: <br />E.Business Fax Number: <br />State: <br />5 1 lJ -2i Q 3 -� 1 u Zip: <br />IJ..u�:55 <br />F.E-Mail Address: b ea.r-t ';}_ IAJe.l( l'.l � �� W)Q_�e �-�fY\ °'; L (f9"V'A-G. Zoning of Business Location: R, r 7\ Ql:I� '2� t'.J.12hH 1.:C: d: 1 S 7o!),d C (.sY>J"Yv.r:.,�e. l <br />H.Have you ever had a Massage Establishment license, or similar licen·se, suspended or revokedby any governing municipality within three (3) years prior to the date of this application: <br />YES NO 'P <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 />J.Include a list of massage therapist employed at this location: (include a sep�rate sheet if necessary) <br />·• { P.Y.u-S�m 00 <br />For Office Use Only <br />Application Filed FEB 2 8 2024 Public Safe ty Approval FEB Z 8 202ij Application Fee Paid Sent to Dept. EEB 2, 8 707.4 <br />HQoll..\-,h� Not Appro,yed Reason <br />license Fee Paid license Number <br />√$.P.iPb-√%Fb <br />1 <br />m 5,E.�Q9d � <br />√ <br />April 23, 2024