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L0 <br />For M municlp0 business license questions, contact: City of South Bend • Department of community Investment CA CJ L <br />227 WestJefFerson Blvd • Suite 14005 -South Bend, Indiana 46601 ■ 574.235.5912 • F, S235.9021 � 1 . OD <br />pec _ b �fs5 + <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New x Renewal <br />11, BUSINESS DATA <br />A. Business Name: King Massage <br />B. Business Address: 2052 E. Ireland Rd. <br />City: South Bend 5tate:IN. Zip. 46614 <br />C. Mailing Address (If different from above): <br />City: State: Zip: <br />D. Business Telephone Number: 574-888-3888 <br />E. Business Fax Number: <br />F. E-Mail Address: jingwang0329@gmail.com <br />G. Zoning of Business Location: Commerical <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 this application: <br />YE5 NO x <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: Massage therapy ` <br />For Office Use Only <br />Application Filed LIAR 1 2 2025 Public Safety Approval <br />Application Fee Paid License Fee Paid MAP I ZM b <br />Sent to Dept. i4 -R 1 2.7M License Number (5— 1U <br />CITY OF SOUTH BEND, INDIANA <br />Not Approved BOARD OF PUBLIC WORKS <br />Reason tj'aa <br />Elizabeth A. Maradik, President <br />�v Gfv�-rites <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: May 27, 2025 <br />