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For aft municipal business Ilrense questions, contaet; City of South ftnnrl - Oppartment of Community Investment <br />227 West Jefferson nlvd • Suite 140() 5 •South RPM, Indiana 4660t - 5/4 235 5912 • F: 5/4./35 9021 <br />LICENSE APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 4-39 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA <br />A. Business Name: ;&4,41C 11 )P,49 KPv0 .LA%C <br />B. Business Address: 2 2D r�,r, l ,f]{�y,r Aje <br />city: forg State: ,4AI Zip: a� <br />C. Mailing Address (If different from above): •D iW <br />city: e le -MI 01 state: oW Zip: <br />D. Business Telephone Number: Z/6 'gsJ — did z <br />E. Business Fax Number: <br />F. E-Mail Address: Eby -hakfv r�1�..� [ ot,�/ 60-M <br />G. Maximum Number of Vehicles that can be parked at facility at onetime: 6� <br />H. Total Number of Parking Spaces atfacility: li <br />1 <br />I. Hours during which vehicles maybe storecjflf 1di P Sir ►ry�rta� fry`- �3n,+�!' l �� <br />H. Premises are b A check one): Leased <br />( ) y Applicant pp 1/"._Ownetl by Applicant <br />If Leased: <br />Owner's Name: < AO Z-1— 4f <br />Owner's Business Address: 124 c4 a _42 '% 95t mjt Ak-wk <br />City: ro rt 1'✓Ritli C State: Zip: AZ y <br />Owner's Residential Address: 12 4 ogA45 wt r4lrrl% <br />State: T/✓ Zip: <br />Insurance Carrier and Amount of Liability Insurance OR Bonding Agent and Amount of Bond: <br />For Office Use Only <br />Application Filed MAY 2 9 2025 Public Works Approval <br />Application Fee Paid License Fee Paid <br />Sent to Dept. MAY 2 License Number. <br />Not Approved <br />Reason <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />Elizabeth A. Maradik, President <br />� <br />Gary A. Gilot, Member <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Breana Micou, Member <br />Attest: Hillary R. Horvath, Clerk <br />Date: September 9, 2025 <br />