HomeMy WebLinkAboutNew Massage Establishment - Sai Shakti Massage & HealingINTER -OFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
TO:
FROM:
SUBJECT:
LOCATION:
DATE DUE:
FAX OR E-MAIL TO:
DATE SENT: 1/5/2018
Federico Rodriguez, Fire Department
Larry Magliozzi, Area Plan
Angela Smith, Area Plan
Wrnes Burns, Police Deu rtmeat—
(\Chris Dressel, Community Investment
Linda M. Martin, Clerk &_
NEW - MASSAGE ESTABLISHMENT LICENSE
RECOMMENDATION-Sai Shaktii Massage & Healing
115 N. William St.Ste..204
January 16, 2018
235-9171 1 l ma rti n(a)_south be n d i n.gov
RECOMMENDATIONS AND COMMENTS:
By Date
For all municipal business license questions, contact: City of South Bend -Department of Community Investment
227 West Jefferson Blvd - Suite 14005 -South Bend, Indiana 46601 ® 574.235.5912 - F:574.235.9021
'Re (,, NO . S-7 (P 024 !�$ WE
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35,
I. APPLICATION TYPE Check One
BUSINESS DATA
New— X Renewal
A. Business Name: 'S MV-7 i AA(:;E AMD 14iUaLl�)a
B. Business Address: N, \NktL,�)—E , -L D L+
City: �u �M_4 2UV13'1D State: —Zip:: [-(- coc) I
C. Mailing Address (If different from above): 14 C_OTTAC-�_E cw_ov�_-- A V�
City: 'Qw'"�b State: v's —zip: 4WL'1Ise
D. Business Telephone Number: C) C)
E. Business Fax Number: F. E-Mail Address: �awrct @ m xEc,,ffle . ED f"
G. Zoning of Business Location: M
H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked
by any governing municipality within three (3) years prior to the date of this application:
YES NO
1. If yes, what was the reason:
2. If yes, what was the, business occupation following the suspension/revocation:
I. Describe the nature and scope of the business:
For Office Use Only
Application Filed JAN 0 42018 Public Safety Approval
Application Fee Paid JAN 0 4 2918 License Fee Paid --- jAN 0 4 2018
Sent to Dept. JAN 0 4 2013 License Number IT,03 e
Not Approved
Reason
A11),U0,ktjWD
13ymrd of p1lblic T
0,4 8
For ail municipal business license questions, contact: City of South Bend • Department of community Investment
227 west Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 + 574,235,5912 • F: S74.235,9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III. OWNERSHIP
A. Type of ownership (check one):
Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (If corporation, proceed to 3).
1. Sole Proprietor
NaFri e:��G ljl1�Y �(e tin +✓�."
Residential Address: t�+y�7� G VD ye
City: 1�xAkI Y, a� Y� State: �� Zip: (Q i
2. Partnership (List at least two (2) partners)
Name #1:
Residential Address:
City:
Name #2:
Residential Address:
City:
3. Corporation
State:
State:
Legal name of corporation:
Date and state of incorporation:
List officers and directors who own 15% or more of stock:
Name #1:
Title:
Zip:
In
Business Address:
City: State: Zip:
Residential Address:
City: State: Zip:
Name #2,
Title:
Business Address:
Cltv:
Residential Address:
City:
2
State:
State:
Zip:
Zip:
For all municipal business license questions, contact; City of South Bend • Department of Community Investment
227 West Jefferson Blvd + Suite 14005 -South Bend, Indiana 46601 •574.235.5912 • F; 574.735.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
IV.'PERSONAL DATA (Continued)
N. Photographs:
� _ _ri4...-I.;s,,, „F Fhf� nnxiir��9•Inn
O. Please list all previous employment for three (3) years prior to the date of this application:
Company Address
mil-'
(Attach additional sheets if necessary)
City, State, ZIP Dates
V. INCLUDE WITH APPLICATION:
Three (3) passport photos taken within 6 months of application.
VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VII. AFFIRMATION
I, hereby, certify and affirm that all of the information I have given in this application is true and
accurate to the best of my knowledge. I further certify that I have in no way attempted to
mislead the City in this application by omitting facts known to me. I agree to cooperate with any
review conducted pursuant to the licensing procedures, including permission to enter and
inspect the place of business and facilities in conjunction with such review. I have read and
understand the regulations of the Massage Establishment and/or Therapist license found in the
City of South Bend Municipal Code, Section 4-35.
`c�
Signature
4
Date
NOTICE OF PUBLIC HEARING
ON
APPLICATION FOR
MASSAGE ESTABLISHMENT
Notice is hereby given to all interested individuals that the Board of Public Works of the
City of South Bend, Indiana, will conduct a Public Hearing at 9:30 a.m. on Tuesday',
February _13,_ 2018 in the Board of Public Works Room, Room 1308, County -City
Building, 227 W. Jefferson Blvd., South Bend, Indiana, on the application for a new
License Application for a Massage Establishment, Sai Shakti Massage & Healing, 115 N.
William St., Ste. 204, South Bend, IN 46601.
Interested persons may be heard on this matter at the Public Hearing or may file with the
Board of Public Works a Memorandum in support of or in opposition to the issuance of
such license.
BOARD OF PUBLIC WORKS
Linda M. Martin, Clerk
Publish one (1) time:
January 26, 2018
1316 COUNTY -CITY BU1.b1NG
227 W. JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1830
CITY OF SOUTH BEND PETS BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
January 16, 2018
Ms. Laura M. Rifkin Fickett
715 Cottage Grove Ave
South Bend, IN 46616
RE: Public Hearing --- License Application for Massage Establishment
Dear Ms. Rifkin Fickett:
PHONE 5741235-9251
FAX 574/235-9171
The Board of Public Works is in receipt of your License Application for a Massage Establishment at 115
N. William St., Ste. 204., South Bend, IN 46601.
Pursuant to the City of South Bend. license ordinance requirements, a Public Hearing on the application
must be conducted by the Board.
The Board of Public Works has set the Public Hearing for 9:30 a.m., February 13, 2018 in the Board of
Public Works Room, Suite 1308, 13th Floor, County -City Building, South Bend, Indiana. You, or your designee,
must be present to answer questions with regard to the proposed business activity.
If you have any questions, please call me.
Sincerely,
Linda . Martin, Clerk
Enclosure
c: Michelle Adams, Licensing
GARY A. GILoT DAVID P. RELOS ELIZABETi-i A. MARADIK JAMES A. MUELLER TFiERESE J. DORAU
NOTICE OF PUBLIC HEARING
ON
APPLICATION FOR
MASSAGE ESTABLISHMENT
Notice is hereby given to all interested individuals that the Board of Public Works of the
City of South Bend, Indiana, will conduct a Public Hearing at 9:30 a.m. on Tuesday,
February 13, 2018 in the Board of Public Works Room, Room 1308, County -City
Building, 227 W. Jefferson Blvd., South Bend, Indiana, on the application for a new
License Application for a Massage Establishment, Sai Shakti Massage & Healing, 115 N.
William St., Ste. 204, South Bend, IN 46601.
Interested persons may be heard on this matter at the Public Hearing or may file with the
Board of Public Works a Memorandum in support of or in opposition to the issuance of
such license.
BOARD OF PUBLIC WORKS
Linda M. Martin, Clerk
Publish one (1) time:
January 26, 2018