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For all municipal 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 />Rcc_(�a�0,760 f <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT CAO <br />MUNICIPAL CODE SECTION - 4-35 <br />K (-_ VV 0 VVAIEiz� <br />I. APPLICATION TYPE Check One: New X Renewal <br />II. BUSINESS DATA <br />A. Business P <br />B. Business I <br />City: <br />C. Mailing Address (If different from above): <br />te: LA) Zip: <br />City: State Zip: <br />D. Business Telephone Number: �52� 2Z20 8 <br />E. Business Fax Number: <br />F. E-Mail Address: / , IAI- Yt /V 7rr li.!] ccy7 <br />G. Zoning of Business Location: NG <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 thisapplication: <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: nkeq q�� I <br />as&ee <br />For Office Use Only <br />Application Filed J UN 1 3 2024 Public Safety Approval <br />Application Fee Paid JON 1 3-2024 License Fee Paid JUN 1 3 2024 <br />Sent to Dept. J UN 1 2 2024 License Number fYl S C9,CA4 - 0 14 <br />z o 6 t 1N 1 7 2024 ✓ Pe �Wj 4 2024 v�' �-J UN 1 7 2024 <br />Not Approved <br />Reason <br />1 <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />12aLa <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />101—M — <br />Joseph R. Molnar, Vice President <br />Brian///Miimm, Member <br />Y �_ <br />Attest: Theresa M. Heffner, Clerk <br />Date: August 13, 2024 <br />