Laserfiche WebLink
For all municipal husinesslionnsequestions,cnted:City&South Bend• 0epartmeMof Community Investment CARD <br />222 WertleNrwn Blvd • Suite 14005 -South Bend, Indiana 46601 a 574.235.5912, F: 574.235.9021 <br />ReC.901753 <br />LICENSE APPLICATION FOR - MASSAGE ESTABLISHMENT <br />MUNICIPAL CODE SECTION -4-35 <br />I. APPLICATION TYPE Check One: New Renewal �\ <br />II. BUSINESS DATA A. Business Name: 50W K <br />B.Business Address:!41 � < 1 ZQAOIL iulkm6 <br />CHy: State: Zip: <br />C. Mailing Address (If r ifferentfrom above): <br />CRY: kA ff.� State: Zip: <br />'7 <br />D. Business Telephone Number: )l�— 314 � f WY <br />E. Business Fax Number: <br />F.E-Mail Address: <br />G. Zoning of Business Location: <br />H. Have you ever had a Massage Establishment license, or similar license, suspended or revoked <br />by any governing municip lity within three(3) years prior to the date of this application: <br />YES NO <br />1. If yes, what was the reason: <br />2. If yes, what was the business occupation following the suspension/revocation: <br />I. Describe the nature and scope <br />For Office Use Only <br />Application Filed FEB 2 42026 Public Safety Approval <br />Application Fee Paid' 4 2025 License Fee Paid F FH 2 4 207F, <br />Sent to Dept. License Number /Y1sEmAS-007 <br />CITY OF SOUTH BEND. INDIANA <br />BOARD OF PUBLIC WORKS <br />Not Approved -Eiga cs�2ayl <br />Reason <br />Elizabeth A. Mamdik, President Joseph R. Molnar, Vice Presidcni <br />Gary A. Hurt Member Breana Micou, Member <br />Murray L. Miller, Member Attest: Theresa M. Heffner, Clerk <br />Date: AP^I 22, M25 <br />