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f '" '<\ �li�E::Olu��::nEt P:���dA�l �u�lic Works <br />�\<_ 227 W. Jefferson Boulevard, Ste. 1316 • South Bend, IN 46601 I RESTAURANT/BUSINESS INFORMATION: <br />N f R t t/B . The General Deli & Cafe ame o es au ran usiness: __________________ _ <br />Address of Proposed Sidewalk Cafe: 609 E Jefferson Blvd <br />Mailing Address: 609 E Jefferson Blvd. South Bend, IN 46617 <br />I APPLICANT INFORMATION: <br />Applicant Legal Name: John M Barany II Phone: 57 4-220-6659 <br />Title: Ii!! Owner □ Manager □Other _______________ _ <br />Email Address: thegeneraldeli@yahoo.com <br />I INCLUDE THE FOLLOWING ITEMS WITH YOUR APPLICATION: <br />□Completed application including $10 fee. Make checks payable to City of South Bend. <br />□Site plan depicting the proposed sidewalk cafe showing placement/dimensions. <br />□Completed Agreement <br />□Certificate of Insurance ($1,000,000/occurrence and $300,000 person naming the City <br />of South Bend 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 <br />South Bend Municipal Code and with all the provisions stated above as conditions of the <br />issuance of this Permit. I further agree to indemnify, defend and hold harmless the City of <br />South Bend from any liability, loss, cost, damage or expenses, including attorney fees, which <br />the City may suffer or incur as the result of any use of the public sidewalks for a sidewalk <br />cafe as permitted herein. I do hereby certify and affirm that all the information given in this <br />application is true to the best of my knowledge. <br />OFFICE USE ONLY: <br />Date Received: /J.... "'I'.? <br />\ 6 a,:-;-r Approval Date: