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1 <br />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 /> <br /> <br /> <br />LICENSE APPLICATION FOR – TATTOO & BODY PIERCING ESTABLISHMENT <br />MUNICIPAL CODE SECTION – 13-125 – 13-152 <br /> <br />I. APPLICATION TYPE Check One: New Renewal <br /> <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. E-Mail Address: <br />G. Federal Employer Identification Number (EIN): <br />H. Indiana Taxpayer Identification Number: <br />I. Zoning of Business Location: <br />J. Have you ever had a Tattoo/Piercing Establishment license, or similar license, suspended or <br />revoked by any governing municipality within three (3) years prior to the date of this <br />application: <br />YES NO <br /> <br />1. If yes, what was the reason: <br /> <br />2. Describe the nature and scope of the business operation: <br /> <br /> <br /> <br /> <br />For Office Use Only <br /> <br />Application Filed Police Dept. Approval <br />Application Fee Paid Fire Dept. Approval <br />Sent to Dept. Building Dept. Approval <br />Health Dept. Approval License Fee Paid <br />License Number <br />Not Approved <br />Reason