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For all municipal business license questions, contact; City of South Bend -Department of CCrnrnrnity Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend. I ndiana 46601 • 574.235.5912 + F: 574.235.9//0''��22 {j r y� � <br />LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT j 01 S U0t <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: <br />IL BUSINESS DATA <br />New Renewal <br />A. Business Name: � 1 9 2se, „I;p <br />B. Business Address: 14+'� 0 'Vje � <br />City: �1"1t.f."�i�i Rod State:_ <br />C. Mailing Address (If different from above): &*6 <br />Zip: b i <br />City: State: Zip: <br />D. Business Telephone Number:d� <br />E. Business Fax Number: 'INN <br />F. E-Mail Address; 4M_V_q (AG , 'gmal l' CAw- <br />G. Zoning of Business Location:�thI+ <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municipalit within three (3) years prior to the date of this application: <br />YES NO <br />1. If yes, what was the reason: <br />Z_ If yes, what was the business occupation following the suspension/revocation.- <br />the naturg and scope of the business: <br />For Office Use Only <br />Application Filed Public Safety Approval J 4 J <br />Application Fee Paid License Fee Paid APR <br />Sent to Dept. 4 P R j 4'212; License Number R&C 5-02'1— Q 1-7 <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />M, <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: May 13, 2025 <br />