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For all municipal business license questions, mntaM City of South Bend • Department of community investment um <br />227 West Jefferson Blvd • suite 1400 S -South Bend, Indiana 45501 ■574.235.5912 - F: 574.235.9021 <br />RfC. �fll77�i <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: <br />II. BUSINESS DATA <br />New Renewal )� <br />A. Business Name: King Asian Massage <br />B. Business Address: 914 S. Ironwood ❑r. <br />city: South Bend <br />C. Mailing Address (If different from above): <br />State: IN <br />lip: 46615 <br />City: State: Zip: <br />D. Business Telephone Number. 574-855-4254 <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 />YES NO x <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation fallowing thesuspension/revocation: <br />I. Describe the nature and scope of the business: Massage Therapy <br />For Office Use Only <br />Application Filed FEB 2 S 2025 Public Safety Approval <br />Application Fee Paid FEE $ 225 License Fee Paid <br />Sent to Dept_� license Number M S615 dAS_Q 13 <br />�y& CITY BOARD FOFO UTH BEND, DIANA <br />UBLIC WO K <br />PQl <br />Not Approved <br />Reason <br />Elizabeth A. Maradik, President Joseph R. Molnar, Vice President <br />_ <br />Gary A. Gilot, Member Briana Micou, Member <br />Murray L. Miller, Member <br />d al&A�£A,,dL / Aar <br />Attest: Hillary Horvath, Acting Clerk <br />Date: 6/24.17 5 <br />