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APPLICATION FOR SIDEWALK CAFIk PERMIT <br />CITY OF SOUTH BEND, INDIANA <br />DATE <br />Applicant's Legal Name John Barany Title <br />Business Name The General Deli & Caf6 <br />Address <br />Telephone Number <br />609 & 613 E. Jefferson Blvd. South Bend. IN 46617 <br />Proposed Location and Description of Sidewalk C66 <br />Outdoor seating for Deli customers at Caf6 and picnic tables on front sidewalk <br />FEE PAID <br />Owner <br />Days of Sidewalk Cafd Operation I <br />Hours of Sidewalk Caf6 Operation <br />Sun <br />Mon <br />Toes <br />Wed <br />Thurs <br />Fri <br />I Sat <br />Closed <br />7a-10 <br />7a-10 <br />7a-10 <br />7a-I1 <br />7a-1 l <br />9a-9 <br />The following information is REQUIRED for completion of a Sidewalk Caf6 Application: <br />1. Completed/signedapplication, including a $10.00 fee <br />2. Drawing(s) and description of proposed sidewalk cafe showing placement/dimensions of proposed <br />caf6 <br />3. Completed/signed Agreement <br />4. Certificate of Insurance ($1,000,000/occurance and $300,000/person, naming the City of South Bend <br />as additional insured) <br />AFFIRMATION <br />I, the undersigned, agree that I will abide by all of the provisions of Section 18-15 of the South Bend Municipal <br />Code and with all the provisions stated above as conditions of the issuance of this Permit. I further agree to <br />indemnify, defend and hold harmless the City of South Bend from any liability, loss, cost, damage or expenses, <br />including attorney fees, which the City may suffer or incur as the result of any use of the public sidewalks for a <br />sidewalk caf6 as permitted herein. I do hereby certify and affirm that all the information given in this application is <br />true to the best of my knowledge. <br />.�211 6,, Q�exze� <br />Date SipWire of p licant <br />John M. Barany, H <br />Printed Name <br />Owner <br />BOARD OF PUBLIC WORKS APPROVAL <br />resident Member Member <br />Mem��� <br />Member <br />01(r.I <br />Date !! <br />RETURN FORM TO: <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 • Fax: (574) 235-9171 • E-Mail: publicwks@southbendin.gov <br />