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Far ali municipal business license questions, contact: City of South Bend • Oepartmentof Community Investment <br />227 West Jefferson Blvd • Suite 1400 S ►South Bend, Indiana 46601 * 574.235.5912 + F: 574.235.9021 <br />LICENSE APPLICATION FOR -MASSAGE ESTABLISE� �TT��a� <br />MUNICIPAL CCDE SECTION -4-35 [? t7o <br />I. APPLICATION TYPE Check One: New Renewal <br />II, BUSINESS DATA f - <br />A. Business Name: LiN SJu� Li <br />B. Business Address: <br />City: OL V�jt(;4cj <br />C. Mailing Address (If different from above): <br />City: <br />:p: <br />D. Business Telephone Number. ?7_tL± <br />E. Business FaxNumber: <br />F. E-Mail Address: yl'Inana Cf.,s 1006 C vlrl f . com <br />G. Zoning of Business Location: e!i: i , l <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 C <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: AL <br />. I- 1 e n. _ <br />For Office Use Only <br />Application Filed FEB 2 4 ?02 Public Safety Approval <br />Application Fee Paid{ p R 2 It 202 License Fee Paid I_ PR �� 4 � F <br />Sent to Dept. R 2: 4 7ii75 _ License Number ra <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 />�— <br />Gary A. Gilot, Member <br />.4 79't.A�-, <br />L/1• l� <br />Breana�Miicou, Member <br />' "/v <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: April 8, 2025 <br />