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For all municipal business Ilee nse questions, contact: City of south Bend • Department of Community Investment <br />Z27 West Jefferson Blvd • Suite 1400 5 ■5auth Bend, Ind lane 46601 • 574.235.591-2 ■ F: 574.235.9021 <br />RAC Aot 7bq op <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT I�K 11ST <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA <br />A. Business Name: �Z�k V'yrG �1acict LLL <br />B. Business Address: 2A14 4e. hNis',"Woxa J'+vG <br />city: se State: 10 Zip: 4101D <br />C. Mailing Address (If different from above): <br />City: <br />State: <br />D. Business Telephone Number: 5114- SI 3 —2 24 4 <br />E. Business Fax Number: <br />Zip: <br />F. E-Mail Address: �V�ky- a ct sb Q ci , to <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 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: <br />4 a S is f �. Vmp Classes . ho A j s e_ <br />For Office Use Only <br />Application Filed FEB 2 5 2025 Public Safety Approval <br />Application Fee Paid FEB 2 5 2D? License Fee Paid FEB <br />�Sent tof Dept._-y �-7--F E 25 799 license Number <br />•' P����7 ~ I7 CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Not Approved i*t�a <br />Reason <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />Gary A. Gilot, Member <br />Breeana Miicou, Member <br />y- t1.1. / /'.`. <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: May 13, 2025 <br />