HomeMy WebLinkAboutMassage Establishment - Therapeutic Indulgence LLCINTER -OFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE SENT: 3/212018
TO: %XFederico Rodriguez, Fire Department
(Larry Magliozzi, Area Plan Commission
�( Angela Smith, Area Plan Commission
ames Burns, Police De rtment
FROM: 00Linda M. Martin, Clerk
SUBJECT: RENEWAL - MASSAG ESTABLISHMENT LICENSE
RECOMMENDATION
Therapeutic Indulgence, LLC.
LOCATION: 903 E. Jefferson Blvd
DATE DUE: March 6, 2018
FAX OR E-MAIL TO: 235-9171 1 Imartin(a)_southbendin.goy
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. t C',
i I
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION'TYPE CheckOne: New
Il. BUSINESS DATA
A. Business Name: THERAPEUTIC INDULGENCE LLC
Renewal XXX
B. Business Address: 90'3 E. JEFFERSON BLVD.
City: SOUTH' BEND State: IN Zip: 46617
C. Mailing Address (If different from above):
City: — — State: Zip:
D, Business Telephone Number: 574-520-1664
E. Business Fax Number:
F. E-Mail Address: THERAPEUTICINDULGENCE@GMAIL.COM
G. Zoning of Business Location. MU
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:
1 If yes, what was the business occupation following the suspension/revocation:
I. Describe the nature and scope of the business:
C e -7mmx . . ...... L.-
For Office Use Only
Application Filed MAR 0 1 2018 Public Safety Approval
Application Fee Paid HV AH 0 1 2018 License Fee Paid
FAR 0 1 2018 - -- A Sent to Dept. License Number 16 P50
Not Approved of pjj�jlv
Reason
For all municipal business license questions, contact: City of South Bend • [Department of Corn munity Investment
227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION 4-35
III. OWNERSHIP
A. Type of ownership (deck one):
t/ Sole Proprietorship (If sole proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (If corporation, proceed to 3).
1. Sole Proprietor
Name: 7' er1 ' �Z.o't
Residential Address: %U1C\ ,0 a\��lv
City: ' �i ,��J _ —State:`� --.Zip:_
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:
Business Address:
City: State:
Residential Address:
City: State:
Name #2:
Title:
Business Address:
City:
Residential Address:
City:
2
State:
State:
Zip:
IN
zip:
Zip:
Zip:
Zip:
For aII municipal business IIce nse questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400S -South Bend, Indiana 46601 •574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR -- MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
IV. PERSONAL DATA (Continued)
N. Photographs:
Company
)ort
ntil
us employment forth ree (3) years prior to I:he date of this application:
Address City, State, ZIP Dates
(Attach additional sheets if necessary)
V. INCLUDE WITH APPLICATION:
Three (3) passport photos taken within 6 months of application.
VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VIL 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 Rend Municipal Code, Section 4-35.
4
Signature
4
Date