HomeMy WebLinkAbout515 BROADWAY ST INVOICE DATE DUE DATE INVOICE# TOTAL DUE
�i� 11 $80.00
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Customer#: 20953 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
KWIK STOP#4 715 Mulberry St
515 BROADWAY ST WATERLOO, IA 50703
WATERLOO,IA 50703
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION - 515 BROADWAY ST-3-20-23 FOR BILLING INQUIRY: (319)291-4323
L Description 1 Total Price
INSPECTION 2,000 $70.00
OCCUPANCY FEE $10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
20953 04/26/2023 04/05/2023 2023-00011173 $80.00
Less Prepayment $0.00
Total Due $80.00
City of Waterloo
P,SER(O
WATERLOO FIRE RESCUE ‘ q
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INSPECTION REPORT
KWIK STOP 4,515 BROADWAY ST,BLDG 515 BROADWAY ST,WATERLOO IA 50703 4400
DETAILS
Inspection Date:03/20/2023 I Inspection Type:Annual Inspection(1Yr) I Inspection Number:7795 I Shift: N/A I Station: N/A
Unit: N/A Lead Inspector:JEFF SIEBEL I Other Inspectors: N/A I Fee:$80.00
STATUS CODE DESCRIPTION
FAIL 1203.2.6-Exit signs. Emergency power shall be provided for exit signs as required in Section 1013.6.3.The
system shall be capable of powering the required load for a duration of not less than
90 minutes.
Inspector:JEFF SIEBEL-Comments:repair exit/egress light above main door.
GENERAL NOTES
JEFF SIEBEL-03/21/2023 @ 09:45 annual inspection$80
JEFF SIEBEL-03/21/2023 @ 09:50 obstructions removed from in front of electrical panel during inspection.
JEFF SIEBEL-03/21/2023 @ 09:50 kitchen out of service.
REINSPECTION DATE
04/11/2023
CONTACT SIGNATURE
Mohammad Sarwat �, (A
Signed on:03/21/2023 @ 09:45
VLF/
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on:03/21/2023 @ 09:46 //17i
Printed on 03/21/2023 @ 09:50
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QUESTIONS ABOUT YOUR INSPECTION?
JEFF SIEBEL
Jeff.Siebel@Waterloo-ia.org
3192301224
Printed on 03/21/2023 @ 09:50
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