HomeMy WebLinkAbout1636 W 4TH ST OFT W A TF INVOICE DATE DUE DATE INVOICE# TOTAL DUE
06/22/2023 07/25/2023 2023-00011322 $80.00
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Customer#: 6004 Please Make Check Payable and Remit To:
City of Waterloo
A TTN: City Clerk/Accounts Receivable
KWIK STAR#715 715 Mulberry St
1626 OAK ST WATERLOO, IA 50703
LA CROSS, WI 54602
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION- 1636 W 4TH ST- 6-8-23 FOR BILLING INQUIRY: (319)291-4323
lDescription f Total Price
INSPECTION 2,000 $70.00
OCCUPANCY FEE
$10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
6004 06/22/2023 07/25/2023 2023-00011322 $80.00
Less Prepayment $0.00
Total Due—÷ $80.00
City of Waterloo
Failure to pay in full debts listed herein within ninety days of the due date will result in an additional twenty-five percent
late fee applied to any outstanding balance. The delinquent account will be forwarded to Municipal Collections of
America for further collection efforts. Debts shall also be subject to collection through the Iowa Department of
Administrative Services Offset Program if not paid in full within ninety days.
b
WATERLOO FIRE RESCUE9 NJ ,
INSPECTION REPORT v,
KWIK STAR#715, 1636 W 4TH ST,BLDG 1636 W 4TH ST,WATERLOO/A 50702
DETAILS
Inspection Date:06/08/2023 ' Inspection Type:Annual Inspection(1Yr) g Inspection Number:8184 Shift: N/A i Station: N/A
Unit: N/A Lead Inspector:JEFF SIEBEL Other Inspectors: N/A ! Fee:$80.00
VIOLATIONS
No Violations Found
GENERAL NOTES
JEFF SIEBEL-06/09/2023 @ 12:54 annual inspection$80
JEFF SIEBEL-06/09/2023 @ 12:57 corrected during inspection:electrical panels blocked
JEFF SIEBEL-06/09/2023 @ 12:55 hood cleaning due July 17/2023
NEXT INSPECTION DATE
06/08/2024
CONTACT SIGNATURE
Gary c
Signed on:06/09/2023 @ 12:58
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on:06/09/2023 @ 12:58 111%°>-•`k
Printed on 06/09/2023 @ 12:59
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QUESTIONS ABOUT YOUR INS►ECTION?
JEFF SIEBEL
Jeff.Siebel@Waterloo-ia.org
3192301224
Printed or 06/09/2023 @ 12:59
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