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For all municipal business license questions, contact: City of South Bend - Department of Community Investment t-[LC I1 <br />227 west Jefferson Blvd - Suite 1400 S -South Bend, Indiana 46601 - 574.23S.S912 - F: 574.235.9021 L-STc�77 <br />6eC. � 0173.11 <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 r <br />B. Business I <br />City: <br />New <br />C. Mailing Address (If different from above): <br />Renewal <br />X <br />."W�Zip: "6/(Z' <br />City: State: Zip: <br />D. Business Telephone Number: <br />E. Business Fax Number: <br />F. E-MailAddress: _f 4 weh 66 l R VrA lwo ('e,,',jn <br />G. Zoning of Business Location: <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 ,_ XL-_ <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: MaGS <br />v <br />For Office Use Only <br />Application Filed FEE 1 9 7025 Public Safety Approval <br />Application Fee Paid-, FB ]. 9 7(17Si License Fee Paid i <br />Sent to Dept. FF8 1 9 2025 License Number_(iiSC'A0a,I5,-0C(r <br />jfeal�-�50 %ab <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Not Approved_____ <br />Reason <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member <br />Breana Micou, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: April 8, 2025 <br />