HomeMy WebLinkAboutLicense - Massage Establishment Renewal - Sun Flower Massage Spa LLC1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND TAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
March 26, 2024
Ms. Ping Ye
Sun Flower Massage Spa LLC
168 W. Catalpa Dr.
Mishawaka, IN 46545
285628644ggg.com
RE: Approval — License Renewal of Massage Establishment
Dear Ms. Ye:
At its March 26, 2024 meeting, the Board of Public Works approved your request for
the Massage Establishment at 421 N. Hickory Rd., South Bend, IN 46615.
If you have any further questions, please call this office at (574) 235-9251.
Sincerely,
Is/ Theresa Heffner
Theresa Heffner, Clerk
Enclosures
TH/lh
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BRIANA N. MIcou
INTEROFFICE MEMORANDUM
BOARD OF PUBLIC WORKS
DATE: 01 /22/2024
TO: Brad Rohrscheib, Police Department
St. Joseph County Health Department - see attached
Gerard Ellis, Fire Department
Kari Myers, Zoning Department
FROM: Theresa Heffner, Clerk
SUBJECT: RENEWAL - MASSAGE ESTABLISHMENT LICENSE
RECOMMENDATION
BUSINESS NAME: SUNFLOWER MASSAGE SPA, LLC.
ADDRESS: 421 HICKORY RD.
PLEASE INSERT YOUR RECOMMENDATIONS IN THE APPROPRIATE FIELD BELOW,
BASED ON THE FOLLOWING CRITERIA FROM MUNICIPAL CODE SEC. 4-35:
1. The applicant and his/her partners have not been convicted of any crime involving unlawful
deviate conduct, deviate sexual conduct, or unlawful sexual conduct within three (3) years
prior to the date of application. (Verified by PD).
2. The applicant is a minimum of 18 years of age. (Verified by PD)
3. The applicant has passed an inspection from the St. Joseph County Health Department
4. The massage establishment as proposed by the applicant would comply with all applicable
laws, including but not limited to the City's building, zoning, health, fire and safety
regulations. (Fire and Zoning, please verify)
5. A recognizable and legible sign shall be posted at the main entrance identifying the
establishment as a massage establishment. (PW — please verify)
POLICE: Favorable recommendation
FIRE: Favorable
COMMUNITY INVESTMENT: The use is a permitted primary use in the C Commercial
district.
For all 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 - 'PI
74.23W2
4. 3�2 5 -far,�
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT C - .�
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION TYPE Check One:
II. BU51NESS DATA
A. Business Name
B. Business Addres
New Renewal
City: State: Zip:
C. Mailing Address (If different from above):
City: State: Zip:
D. Business Telephone Number: � ji
E. Business Fax Number: )p��, !A
r. E-Mail Address: 29 e4 2S c
G. Zoning of Business Location:
H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked
by any governing municlp ity within three (3) years prior to the date of thisapplication:
YES NO 7
1. If yes, what was the reason:
2. If yes, what was the business occupation following the suspension/revocation:
I. Q,!pscribe the nature and scope of the business:
For Office Use Only
Application Filed J -P' ] $ 224 public Safety Approval
Application Fee Paid'iA l 1 O ZL'Z`I License Fee Paid
Sent to Dept. JAN 1 8 2C24 License Number .Q_4E. )a14_
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Not Approved V'W
Reason
Elizabeth A. Maradik, President
�—.� Gfsilcit�
Gary A. Gilot, Member
4 9yL_1&__1
Murray L. Miller, Member
1,1:;;-2M
Joseph R. Molnar, Vice President
Breana N. Micou, Member
Attest: Laura D. Hensley, Acting Clerk
Date: March 26, 2024
For all mur ldpal business license quesdans, mmxa: My of South Rend • DeW rtment of rnmmunny Imertment
227Westlelierson Blvd • Suite 14005 •south Bend, Indlana 46601 • 57k235.5912 • F:574.235.9021
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
Name: 1 I,[F
Residential Address: 16$ W AN MHA TU)
City: State: Zip:
2. Partnership (List at least two (2) partners)
Name #1:
Residential Address:
City: State: Zip:
Name#Z:
Residential Address:
City: State: Zip:
3. Corporation
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: Zip:
Residential Address:
City: State: Zip:
Name #2:
Title:
Business Address:
City: —State:—Zip:—
Residential Address:
City: State: Zip:
2
Far all mumclpal business license questions, mina¢ CM of south Bend • Department ofCommunsy Imedrnent
227 Wert MHeraon 81W • Suite 14005 -South Band, Indiana 46601 • 514.2355912 • F'. 90.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
III. OWNERSHIP (Continued)
3. Corporation (Continued)
Name p3:
Title:
Business Address:
City: State: TIp:
Residential Address:
City: State: Zip:
IV. PERSONAL DATA
A. Applicant's Legal Name:No
�e���7�,
B. Residential Address: // �n" L�IFA y I �idi�is
City: ��� 9State: Zip: /(
C. Residential Telephone Number: C? SR Sl f% 13T 700\
D. Residential Fax Number:
E. Cellphone Number:
ll pp 3I Z / O
F. E-Mail Address:
G. Position with business: OVJ�`QA
H. Please list all criminal convictions (if any), excluding trefficviolations:
Nature of Conviction City State Date
(Attach additional sheets if necessary)
I. Please list all addresses for three (3) years prior to application date:
Street Address City State Dates
S'Gt lrv��f
(Attach additional sheets if necessary)
K. Gender:
For all municipal business license quesdons, contact City at South Bend • Department ecummundy Investment
227 Westlefferson BIM • Suite 1400 S -South Bend, Indiana 45501. 570.235.5912 • F: 51A2M.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 435
IV. PERSONAL DATA (Continued)
N. Photographs: _
t ....... of thr A,+-.r er.im nnfirntinn
e e ua Ali tthe
( A
Company Address City, State, ZlP D tes
Miracle MGtSSA9ue �o' M�/li lw ubmn 0 0l611
SU hweAnop. 50ah 1mle Wo 120
SU om I � nit 46�rY i7 l013
(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
VII. INCLUDE A LIST OF ALL MASSAGE THERAPIST EMPLOYED BY ESTABLISHMENT
Vill. 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 certify that 1 will not
allow massage therapy to be performed at this establishment by any person who does not
possess a current massage therapist license. 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.
ray 0l�l��2al¢
Signature Date
4