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I ai ki r`ln ft4" <br />l ,. xi <br />APPLICATION FOR DJKWAL CA14? P RMIT <br />CITY OF SOUTH BEND, INDIANA N5, <br />DATE IZ® N6FEE PAID X$10.00 � <br />Applicant's Legal Name Jeremy Young Title Pro rim etor <br />Business Name Woochi Japanese Fusion & Bar, INC. <br />Address 119 N Michigan Street South Bend, IN 46601 <br />Telephone Number 574-220- <br />Proposed Location and Description of Sidewalk Cafe <br />fenced area be <br />tween the side door and main entrance for serwitt »food and Ix -vet <br />Days of Sidewalk Cafe Operation Sun Mon Tues Wed <br />12 p.m. — l l a.m. — 11 a.m 11 a.m. — <br />Hours of Sidewalk Cafd Operation 9 p.m. 10 P.M. 10 P.M. 10 p.m. <br />Thurs Fri Sat <br />11 a.m. — 11 a.m. 12 p.m. — <br />10 P.M. 11 p.m. 11 p.m. <br />The following information is REQUIRED for completion of a Sidewalk Cafe Application: <br />1. Completed/signed application, including a $10.00 fee <br />2. Drawing(s) and description of proposed sidewalk cafd showing placement/dimensions of proposed <br />cafe <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 cafe 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 />4/17/2020 <br />Date <br />Signature of Applicant <br />Jerem Yttttt <br />....Printed Name..... <br />Proprietor <br />Title <br />BOARD OF PUBLIC WORKS APPROVAL <br />BOARD OF^P1 BIA( WORKS <br />�fiw.uLc-u!9<nn�.� i <br />(+n A WA 1' ,eidcnl <br />IhercvcJ JJ i, ilember <br />�(i <br />I <br />11' nboih A. Mdik, Member <br />-__ ;� <br />J,&, V. C ih Me k, <br />AI1LS'1_ <br />— <br />„Cf mr RETURN FORM TO: 4 <br />SCoh R Motaar, n1G ner <br />- — Board of Public Works <br />l,�nde M tlmbn, Clack <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 • Fax: (574) 235-9171 <br />