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For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601 •574.235.5912 • F: 574,235.9021 , <br />6.1 <br />ith <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal k <br />II. BUSINESS DATA <br />A. Business Name: 4�atr Croc�ters <br />B. Business Address: 100a �Llrlcolh W0.V; _St <br />city: .500'1 f VEMA State: / N Zip: q'(O&o l <br />C. Mailing Address (If different from above): <br />City: . State: Zip: <br />D. Business Telephone Number: 5 74( a.8ff-a`AV9' <br />E. Business Fax Number: T-71f 0'33-8370 <br />F.E-Mail Address: c' Alet,t.3in+e_(-Cej5Lc 0 L a [1-Ct <br />G. Zoning of Business Location: 1--8 <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municipality within three (3) years prior to the date of this application: <br />YES NO <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation following the suspension/revocation: <br />1. Describe the nature and scope of the business: r'u t_t- S ER V fc E SA Lo IJ H A I Pear 7 <br />HAIR COLOQ 1-H1LWITS,_MANICUR6.T PC0Ir_kR.6S; FRCiALsilIfkSSAE€ <br />For Office Use Only <br />FEB 13 2017 <br />Application Filed Public Approva <br />Application Fee Paid������ - License aFEB 1. 3 2017 <br />Sent to Dept. FEB 13 2017 License Number 17— a <br />4'P.40 M <br />Not Approved Board of Public Works <br />Reason <br />1 <br />e <br />