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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br />G< 104L� <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:_ <br />B. Business Address: <br />New <br />0 <br />s <br />Renewal _ <br />sJi7k / q 0 <br />City: State:_ Zip: <br />C. Mailing Address (If different from above): <br />City: State: Zip: <br />D. Business Telephone Number: _C�W_:7L.? — ��11 <br />E. Business Fax Number: <br />F. E-Mail Address: n ec. fI LSSCt(i[.�� <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 municip y within three (3) years prior to the date of thisapplication: <br />YES NO <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: _&jLaH., ` <br />For Office Use Only <br />Application Filed F E B 2 5 2025 Public Safety Approval <br />Application Fee Pai(tr _ � License Fee Paid <br />Sent to Dept. ' • ' License Number <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: April 8, 2025 <br />i -3S <br />