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.. .... <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment 227 west Jefferson Blvd• Suite 1400S •South Bend, Indiana 46601 • S74.235.5912 • F: 574.235.R2�C... <br /><a� '39,...C/ I $' 8i S.'w <br />LICENSE APPLICATION FOR -MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />1.APPLICATION TYPE Check One:New :i Renewal ______ _ <br />II.BUSINESS DATAA. Business Name: ---1::-�......__,._...,..,,i-...,__-=--____.-,-_-+---=----!r-------- <br />City:.---==-"<L,;._,_ ......... .......,=------C.Mailing Address (If different from above): ________________ _City : _________ --. __ Stat e:._--::--:--,---Zip: ______ _D.Business Telephone Number:-=5.c...]+-{J.._..._3._�'-:,....._...,.J .... 9_,_,_lf--t ...... ,_ _______ _E.Business Fax Numb�r:t F.E-Mail Address: cdO Ir' 9 l/-&of 6.131uA I • 'Col'V\__ .G.Zoning of Business Location: �Con ................... ro ......... e"'".,C'-'C-\...,f,"l ... JJ"----------------H.Have you ever had a Massage Establishment license, or similar license, suspended or revoked by any governing municipality within three (3) years prior to the date of this application: YES ____ NO 7< <br />1.If yes, what was the reason: __________________ _ <br />2.lfyes, what was th e business occupation following the suspension/revocation: __ <br />I.Describe the nature and scope of the business: _______________ _ <br />J.Include _abs\of massa ge thera pist employed at this loca tion: (include a separate sheet if necessary)c)l01\ 1 •'\ d .I <br />For Office Use Only <br />Application F il e d JAN O 4 2023 Public Safety Approval---:-::-:-:--------Application Fee Paid JAN O 4 2023 License Fee Paid :=='IAN n 4 2023 Sent to Dept. JAN e 4 2023 License Number_M�se-�����-00�.�i _____ _ <br />1N.JAN 1 12023 Z.Vnifltl� JAM O 3 2023 Not Ap proved ____ /lQJ1ic.-dAN.JLU!lll-✓H-e�l-th JAN 1 2 2023Reason ______________________________ _ <br />1 <br />New owner for an already existing massage establishment. <br />February 28, 2023