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For all municipal business license questions, contact: City of South Bend -Department of Community Investment CAP—D <br />227 West Jefferson Blvd - Suite 1400 5.5outh Bend, Indiana 466019 574.235.5912 • F:574.235.13021 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One <br />II. BUSINESS DATA <br />New Renewal <br />A. Business !Name: -L I !;Ph Inas(Zge_ <br />KA <br />B. Business Address: 1 r-- .I� f-r�bh 3,I lfrf <br />City: State: i r, _zip: kh I <br />C. Mailing Address (If different from above): <br />City: State: Zip: <br />D. Business Telephone Number: 0: <br />E. Business Fax Number: <br />F. E-Mail Address: r< J, COig <br />G. Zoning of Business Location: <br />W-AW&W. ZIUME <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 this application: <br />YES NO _ 4-L <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 natu re and scope of the business: <br />I U Pr_nfi p e. _j�— r- j�cz�f <br />For Office Use Only <br />Application Filed FEB 1 0 2025 Public Safety Approval <br />Application Fee PaicFEB 1 0 2M License Fee Paid � Eb � � � �1 <br />Sent to Dept. F ER I A 7 2 License Number a 26- 0(—)q <br />J ea f � 1 ) OU LA CITY OF SOUTH BEND, INDIANA <br />11 BOARD OF PUBLIC WORKS <br />Not Approved 2 yyl <br />Reason 9 <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member <br />Breana Micou, Member <br />f" <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: March 25, 2025 <br />