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For all municipal business license questions, contact: City of South Bend • Department of Community Invest merit CV <br />227 West lefferson Blvd ■ Suite 1400 5 -South Bend, Indiana 46601 ■ 574.235,5912 • F: 574.235.9021 �+ ^4tC <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT C4-577 <br />MUNICIPAL CODE SECTION - 4-35 <br />I. APPLICATION TYPE Check One <br />11. BUSINESS DATA t] <br />A. Business Name: 4�QC <br />B. Business Address: 6itP <br />City: Slw�sv <br />New Renewal V/ <br />1rswwI &A bikj <br />C. Mailing Address (If different from above): <br />City: <br />State:JJ - zip: gtvtb 17 — -- <br />State: <br />D. Business Telephone Number:(ggj <br />E. Business Fax Number: ---- <br />F. E-MailAdd ress: I"QdA( «I)YlAAe -eoo4 (a 41)1QIt, CofyI <br />G. Zoning of Business Location: <br />Zip: <br />H. Have you ever had a Massage Establishment license, or Similar license, suspended or revoked <br />by any governing municipality within three (3) years prior to the date of thisapplication: <br />YES NO_ <br />1. if yes, what was the reason: <br />Z. If yes, what was the business occupation following the suspension/revocation: <br />I. Describe the nature and scope of the business: Pay iL dT 46-alz At wii1AA -'1LI• <br />For Office Use Only <br />Application Filed MAR 2 1 2024 Public Safety Approval <br />Application Fee Paid MAR 1 2024 License Fee Paid u I?. <br />Sent to Dept. MAP 2, 2024 License Number <br />Hea1A—i9go1-16L- S P:>Fa <br />Nt Ad �LPb CITY OF SOUTH BEND, INDIANA <br />opprove <br />Reason <br />BOARD OF PUBLIC WORKS <br />IwLa 7Tt <br />Elizabeth A. Maradik, President <br />Gary A. Gilot, Member <br />P 2—" /. 7—"*- <br />Murray L. Miller, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />6 ;</X,/, �'. <br />Attest: Theresa M. Heffner, Clerk <br />Date: August 13, 2024 <br />