HomeMy WebLinkAbout919 W 5TH ST INVOICE DATE DUE DATE INVOICE# TOTAL DUE
411�\ r;. 11/21/2022 12/26/2022 2023-00011057 $80.00
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Customer#: 13757 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
WEST SIDE LIQUOR 715 Mulberry St
919 W 5TH ST WATERLOO, IA 50703
WATERLOO, IA 50702
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION-919 W 5TH ST- 11-17-22 FOR BILLING INQUIRY: (319)291-4323
Description r Total Price
INSPECTION 2,000 $70.00
OCCUPANCY FEE $10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
13757 11/21/2022 12/26/2022 2023-00011057 $80.00
Less Prepayment $0.00
Total Due— $80.00
City of Waterloo
WATERLOO FIRE RESCUE � �ypSER(OQ
INSPECTION REPORT � vet
WEST SIDE LIQUOR,919 W STH ST,BLDG 919 W 5TH ST, WATERLOO IA 50702 �- 1�
DETAILS
Inspection Date: 11/17/2022 i Inspection Type:Annual Inspection(1Yr) Inspection Number:7250 I Shift: N/A 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-11/18/2022 @ 09:49 annual inspection$80
NEXT INSPECTION DATE
11/17/2023
CONTACT SIGNATURE
Ehsan Aslam
Signed on: 11/18/2022 @ 09:50 P(,L
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on: 11/18/2022 @ 09:50
QUESTIONS ABOUT YOUR INSPECTION?
JEFF SIEBEL
Jeff.Siebel@Waterloo-ia.org
3192301224
Printed on 11/18/2022 @ 09:51
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