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e <br />For aU munlelpal <br />I. APPLICATION TYPE <br />II. BUSINESS DATA <br />A. Business Na <br />B. Business Adl <br />City: _ <br />C. MailingAddl <br />City: CI <br />D. Business Teb <br />E. Business Fax <br />F. E-Mail Addre <br />G. Maximum N1 <br />H. Total Numbe <br />I. Hours during <br />H. Premises are <br />City: <br />Bcen queWons,contacl: CkyofSouth Bend- Dep8rtmemofGammurdtylnvestrnent <br />Blvd -*utte 1400 s -South Bend, Indlana 46601- 574.235.5912 - F. $74 ss:0� 1 <br />CK#� i <br />APPLICATION FOR - PUBLIC PARKING FACILITY <br />MUNICIPAL CODE SECTION - 439 <br />Onq: New <br />Renewal <br />s: 2]4-216 W. WavneSt. <br />uth Ben,o State: IN Zip:46613 <br />(if diffe�'ent from above) 1428 Hamilton Avenue <br />:216-8S7-0262 <br />nber of Vehicles that can be parked at facility atone time: <br />of Parking Spaces at facility: l ()—�4 <br />hick vehicles may be stored: n/a <br />:heck ono): Leased by Applicant Owned by Applicant x <br />Name: _; <br />Business <br />State: <br />Zip: <br />Owner' Residentlal Address: <br />City: State: Zip: <br />i <br />J. InsuranceCa ier and Ajnount of Liability Insurance OR Banding Agent and Amount of Bond: <br />For Office Use Only <br />Application Filed UG 1 o .2016 Public Works Approval <br />Application Fee Paid License Fee Paid <br />Sent to Dept. License Number 1 6 - 773 <br />APPROVED <br />Board of Public Work,, <br />Not Approved <br />Reason i c mP /I i <br />1 <br />