Laserfiche WebLink
For all municipal business license questions, contact: City of south Bend • Department of Community Investment <br />227 West Jefferson Blvd + Suite 140D 5 •South Bend, Indiana 466D1 • 574.235.5 2 • F: 574 235 9021 <br />cc . ICq05,°° <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One <br />II. BUSINESS DATA <br />A. Business Name: 1:_� <br />B. Business Address: <br />New Renewal <br />C. Mailing Address (If different from above): <br />City: <br />D. Business Telephone Number: <br />E. Business Fax Number: <br />1e <br />2 <br />p: b 15 <br />e: Zip: <br />F.E-Mail Address: IIN'0A14.1%�-���f j66Cj3 (kZ1(, r."qm <br />G. Zoning of Business L'ocatlbn: <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 V <br />I. If yes, what was the reason: <br />Z. If yes, what was the business occupation following the suspension/revocation: <br />I. Describe the nature and scope of the business: R LL M'qs G g1' <br />For Office Use Only <br />Application Filed JAKI4 ,i Public Safety Approval <br />Application Fee PaidJ AN U 9 2021: License Fee Paid <br />Sent to Dept. License Number <br />zoniija <br />Not Approved tRL4-6 `A500 I S7 <br />Reason CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />V'a(4 <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />--.v Gfs�+itet <br />Gary A. Gilm, Member <br />77'Lwy <br />Breana Micou, Member <br />�4 <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: Fehruary 11, 9095 <br />