Sidewalk Cafe Permit - Fiddlers Hearth

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SIDEWALK CAFE APPLICATION •f � 1 �r City of South Bend - Board of Public Works 227 W. Jefferson Boulevard, Ste.1316 South Bend, IN 46601 RESTAURANTBUSI NE55 INFORMATION: Name of Restaurant/Business:— Address of Proposed Sidewalk Cafe: AKA -I i .. tl\j `f&fo,!f-,) Mailing Address: 1.2,1 } • ilJ AU1 S -11 APPLICANT INFORMATION: Applicant Legal Name: L'�� 1_ Vl�.RA� Phone: Title: ❑ Owner 21 anager ❑ Other Email Address: INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: 0 Completed application including $10 fee. Make checks payable to City of South Bend. Q Site plan depicting the proposed sidewalk cafe showing placement/dimensions. 12tompleted Agreement E Certificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City of South Bend as additional insured) AFFIRMATION I, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the South Bend Municipal Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk cafe as permitted herein. I do hereby certify and affirm that all the information given in this application is true to the best of my knowledge. Signature of Applicant: Date: OFFICE USE ONLY: e Date Receive Fee Paid: I ��% Approval Date: