HomeMy WebLinkAboutLicense - Massage Establishment Renewal - King Asian Massage1316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
April 23, 2024
Ms. Jing Wang
King Asian Massage
914 S. Ironwood Dr.
South Bend, IN 46615
Jingwan 03�29kgmail.com
RE: Approval — License Renewal for Massage Establishment
Dear Ms. Wang:
At its April 23, 2024 meeting, the Board of Public Works approved your request for
the Massage Establishment at 914 S. Ironwood Dr.
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: 02/23/2024
TO: Brad Rohrscheib, Police Department
St. Joseph County Health Department - see attached
Derek Erquhart, Fire Department
Kari Myers, Zoning Department
FROM: Theresa Heffner, Clerk
SUBJECT: RENEWAL - MASSAGE ESTABLISHMENT LICENSE
RECOMMENDATION
BUSINESS NAME: KING ASIAN MASSAGE
ADDRESS: 914 S. IRONWOOD DR.
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 recommendation
COMMUNITY INVESTMENT: The use is a permitted primary use in the NC
Neighborhood Center district.
For all municipal business license questions, contact. City cf south Bend • Deparfinentof Community Investment NC', i
227 West Jefferson Blvd • Suite 1400 5 -South Bend, Indiana 46601 0 514.235.5412 - F: 574.235{�9022Ji / I - ��)T V
i ] e c , 6 �ito �Ci` !
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT 59,1�5 VD
MUNICIPAL CODE SECTION - 4-35
I. APPLICATION TYPE Check One
II. BUSINESS DATA
New Renewal X
A. Business Name: King Asian Massage
B. Business Address: 914 s Ironwod dr
cIty_5outh Bend
C. Mailing Address (if different from above):
ON Zip. 46615
City: State: Zip:
D. Business Telephone Number: 574-855-4254
E. Business Fax Number:
F. E-Mail Address: Jingwang0329@gmall.com
G. Zoning of Business Location-
H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked
by any governing municipality within three t3j years prior to the date of thisapplication:
YES NO x
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: massage therapy
For Office use Only
Application Filed FEB 2 2 2024 Public Safety Approval
Application Fee Paid Q?4 License Fee Paid
Sent to Dept. ttti Tf, ZT License Number_ �' — 00
HEAL-rq-;4olo3) 56Pb
Not Approved
Reason
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
JC�ri� �a
Elizabeth A. Maradik, President
�v Q� plot
Gary A. Gilot, Member
Murray L. Miller, Member
�77t
Joseph R. Molnar, Vice President
Briana Micou, Member
Attest: Theresa M. Heffner, Clerk
Date: April 23, 2024
For all muNupal business license questions, coma& City of stuff Bend • BCyartment of Community Investment
227 Weztleffersm &vtl • Suite 14005'South Bend, Indiana 466M • 574335.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION -4-35
III. OWNERSHIP
A. Type of ownership (check one):
• Sole Pmprietorship(if sale proprietorship, proceed to 1).
Partnership (If partnership, proceed to 2).
Corporation (If Corporation, proceed to 31.
1. Sole Proprietor
Name: Jing Wang
Residential Address: 914 B Ironwood
Oty: South Bend State:ln
Zip; 46615
2. Partnership (List at leasttwo (2) partners)
Name#1:
Residential Address:
City State:
Zip:
Name #2:
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:
CRy: State:
Zip:
Residential Address:
City: State:
Zip:
2
For all municiW l business license questions, wntart: City of South Bend - Department of Community Investment
227 West Jefferson &vd - Suite 14005-South Bend, Indiana 46601. 574235.5912 - IF 574.235.9021
LICENSE APPLICATION FOR- MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
III. OWNERSHIP (Continued)
3. Corporation (Continued)
Narl
Business Address:
Residential Address:
IV. PERSONAL DATA
A. Applicant's Legal Name: Jing Wang
B. Residential Address: 11455 McKinley Hwy.
city. Osceola State;IN 7;p: 46561
C. Residential Telephone Number: 312-874-0115
D. Residential Fax Number:
E. Cellphone Number: 312-874-0115
F. E-mail Address: Jingwang0329@gmaii.com
G. Position with business: Owner
H. Please list all criminal convictions (if any), excluding trafficviolations:
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
4242 Irish hills dr. Southbend IN 6-2021/ 10/2022
3
for all mun cquil business license questions, [nntact Ciry of South Bend • Departmentol Cammunity Investment
227 West Jefferson Blyd • Suite 1400 S -South Bend, Indiana 46601 •574.235.59U • F. 574.2359@3
LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT
MUNICIPAL CODE SECTION - 4-35
IV. PERSONAL DATA (Continued)
0. Please list all previous employment forth ree (3) years prior to the date of this application:
Company Address City, State, ZIP Dates
Kota 4240 Main St. Mishawaka IN 46545
King Sedan massage 914 s Ironwood dr. South Bend In 46616 712022 current
(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. AFFIRMATION
I, hereby, certify and affirm that all of the information I have given in this application is true and
aaurate to the best of my knowledge. I further certify that I have in no way attempted to
mislead the City in this application by omittingfacts known to me. 1 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.
Signature
4
2/19/2024
Date
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