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For all municipal business license questions, contact: Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br />1 <br />LICENSE APPLICATION FOR – RESTAURANT <br />MUNICIPAL CODE SECTION – 4-45 (SEE ALSO 4-46) <br />I.APPLICATION TYPE Check One:New Renewal <br />II.BUSINESS DATA <br />A.Business Name <br />B. Business Address <br />City State Zip <br />C. Mailing Address (If different from above) <br />City State Zip <br />D. Business Telephone Number <br />E. Business Fax Number <br />F.Business E-Mail Address <br />G. Type of Zoning at Business Location <br />H. Number of Employees <br />I. Maximum Seating Capacity <br />J. Do you provide live music or other live entertainment? <br />Yes No <br />If yes, state the type of live entertainment provided <br />K. Do you have pool tables? <br />Yes No If yes, how many <br />III. GENERAL QUESTIONS <br />A.Will food be sold by weight or measure? Yes No <br />If yes, please attach the certificate from the Sealer Weights and Measures. <br />B.Is your restaurant operated by a not-for-profit fraternal organization, service club, or <br />religious, educational, or charitable institution? Yes No <br />If yes, please provide proof of status. <br />For Office Use Only <br />Application Filed Building Dept. Approval <br />Application Fee Paid Fire Dept. Approval <br />Sent to Dept. License Fee Paid <br />Health Dept. Approval License Number <br />Not Approved <br />Reason <br />CONTINUE TO NEXT PAGE