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APPLICATION FOR SIDEWALK SALE PERMIT 1 <br />�� fry=f=��-' •a/�3 <br />CITY OF SOUTH BEND, INDIANA 'labs,! Fs <br />JT i <br />NEW RENEWAL ❑ DATE (� <br />PERMIT FEE IS $10.00 PER YEAR ❑ Fee is Paid <br />Applicant's Legal Name 1�7� ,[� A Y\., 0 & j2S0 /'L­' Title <br />Business Name fr J l <br />Address <br />Telephone Number 1 -7 <br />Proposed Location and Description of Sidewalk Sale <br />Days of Sidewalk Sale peration <br />Hours of Sidewalk Sale Operation <br />Type of Goods to be Sold <br />Dates of Sidewalk Sale <br />Sun <br />Mon <br />Tues <br />Wed <br />Thurs <br />Fri <br />Sat <br />rC <br />U e-�- P V <br />[Note: This Permit may be utilized by the Permittee only for sidewalk sales directly in front of his/her business <br />establishment. This Permit does not allow the placement of merchandise in front of the business of any <br />merchant other than the Permittee, unless the properties involved are contiguous and the written consent of the <br />other merchant is obtained. Permittee must allow for at least five (5) feet of unobstructed sidewalk for the free <br />flow of pedestrian traffic at all times during the sale.] <br />AFFIRMATION <br />1, 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 sale as permitted herein. I do hereby certi and affirm that all the information given in this <br />applicatio is true the best of my knowledge.4 <br />Date Signature of Applicant <br />Title of Applicant <br />BOARD OF PUBI IC WO S APPROVAL <br />ArG—✓ '' <br />President Member <br />0 G <br />Me er <br />Member <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 />Member <br />9/ fb 7 <br />Date <br />Updated 6/22/12 - I <br />Phone: (574) 235-9251 a Fax: (574) 235-9171 ♦ E-Mail: publicwks@southbendin.gov <br />