Sidewalk Cafe - Purple Porch Co-Op

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APPLICATION FOR SIDEWALK CAFE PERMIT CITY OF SOUTH BEND, INDIANA hem°18� DATE FEE PAID P $ 1 Q(% L Applicant's Legal Name Business Name Address Telephone Number Koehler Porch 123 N. Hill St., South Bend, IN 46617 Proposed Location and Description of Sidewalk Cafd Title V +/� f The part of the sidewalk that is adjacent to our buil ing on the East side running north -south Days of Sidewalk Caf6 Operation Hours of Sidewalk Caf6 Operation Sun on Tues Wed Thurs Fri Sat ]lam- S m 8am- 8 m 8am- 8pm 8am- S m 8am- 8 m 8am- 8pm 8am- 8pm The following information is REQUIRED for completion of a Sidewalk Caf6 Application: 1. Completed/signed application, including a $10.00 fee 2. Drawing(s) and description of proposed sidewalk caf8 showing placement/dimensions of proposed caf8 3. Completed/signed Agreement 4. Certificate of Insurance ($1,000,000/occurance and $300,000/person, naming the City of South Bend as additional insured) AFFIRMATION 1, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the South Bend Municipal Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk caf8 as permitted herein. I do hereby certify and affirm that all the information given in this application is true to the best of my knowledge. � A r 2-22-2017 Date ig atu of Applicant Greg/Koehler Printed Name General Manager Title BOARD OF PUBLIC WORKS APPROVAL President V Member Member .:Member Member 3,i�/�� r7 Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 • Fax: (574) 235-9171 • E-Mail: publicwks@southbendin.gov C!