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For all municipal business license questions, contact: City of South Bend • Department of Community Iavestment <br />227 West Jefferson Aldd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 * F: 574.235.9021 <br />01KS <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II, BUSINESS DATA <br />- <br />A. Business Name: �"liga k'?OL f%ir IJl�lkl�e►ENLL <br />B. Business Address:!30S _IE- z�N_—% <br />City; S..:tit So'..40 State. k). Zip: �lelini <br />C. Mailing Address (If differe ntfrom above): <br />City: State: Zip: <br />D. Business Telephone Number: r7� S20 16LALA <br />E. Business Fax Number: <br />F. E-Mail Address: <br />G. Zoning of Business Location: IWA�D k.11,251e_ <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 />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:, %_k t56Ocka. 115 SXVELL1, %0%5 <br />L <br />For Office Use Only <br />Application Filed FEH 2 4 M9[ Public Safety Approval <br />Application Fee Paid F EB 2 4 zuz5License Fee Paid FEB 2 4 J <br />Sent to Dept. - LicenseNumber Se 9A 7 <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />tul4 <br />Elizabeth A. Maradik, President <br />` 9- , Q"'.- <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />SKI <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: March 25, 2025 <br />