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For 411 municipal business license questions,contact: City of South Bend• Department of Community Investment jw'�IVNO <br />227 West Jefferson Blvd • Suite 1400 S -South Bend, Indiana 46601. 574.235.5912 •rno.235.9g:a q 3 4 374N �5 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One: New Renewal <br />II. BUSINESS DATA A. Busyness Name. b? 641 W L )-oy A".ssAGF— <br />B.BusinessAddress:4-4 1•:-lCKobf gokh <br />City: 5;00rt- F.JQ4b State: li l zip: 44bf S <br />C. Mailing Address (If different from above): 55&01 *Q!�" �PA/ <br />City: r7011131- ' rl State: t. ILL Zip: 46614- <br />D. Busines' Teleph6de-ITffrlffber. " <br />E. Business Fax Number. <br />— F. E-M'ail Address: `alio, Q -� <br />G. Zoning of Business Location: <br />H. HaV.e 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 1. Describe the nature and scope of the business: r"6i) s-m—t< 1ME&APj <br />AS�LLOw Et1 11��i4-PPC te—+Bt.E GrTY I�" DEt1 11��i4-PPC tce4B-E GsTY /�" D <br />�D�i9i�T��—tJ�lrttAi-ICES. - <br />I <br />Application Filed <br />Application Fee i <br />Sent to Dept. <br />FEB 2 4 2017 <br />For Office Use Only <br />License Number <br />Board of PD161 c Works <br />NotApprovedi MAR 14 Nt7 <br />Reason <br />