HomeMy WebLinkAbout1105 CRDAR BEND DR INVOICE DATE DUE DATE INVOICE# TOTAL DUE
/''1 Elk 8reF; 06/20/2018 07/20/2018 201 -
��s1rt9�/ 00000407 $80.00
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Customer#: 5019 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
KWIK STAR#724 715 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- 1105 CEDAR BEND DR- 6-15-18 FOR BILLING INQUIRY: (319)291-4323
L Description I Total Price
J
INSPECTION 2,000 $70.00
OCCUPANCY FEE $10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
5019 06/20/2018 07/20/2018 2018-00000407 $80.00
Less Prepayment $0.00
Total Due--* $80.00
City of Waterloo
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Commercial Fire Inspection.Report
Inspection Number 1578
Prior Inspection 459
Number Fill this field if it is available, it will auto-fill business name and address.
Inspector* Jeff Siebel
Waterloo Fire Rescue
715 Mulberry Street Waterloo, IA 50703
Phone(319)-230-1224 Fax. (319)-291-4262
Email:Jeff.Siebel@waterloo-ia.org
File Upload
Address* 1105 Cedar Bend Drive
Business name Kwik Star#724
Inspection Date* 6/15/2018
Proprietor Shelly Harkrider
Business Phone 319-234-8196
Email* seservicedesk@kwiktrip.com
Email 2 licensing@kwiktrip.com
Property Owner Kwik Trip Corp
Emergency Contact Shelly Harkrider
Information
Phone 319-610-9410
Violations
Ref# CODE Violation&Location Corrected
1
Comments: No violations noted at this time.
Emergency Fuel Stop device functions ok
If violations noted during the inspection are not corrected by the given re-inspection date,additional fees
are as follows:
$100.00-First Re-inspection I$150.00-Second Re-inspection I$200-Third and subsequent Re-inspections
Reports
Reports Fire Extinguisher S,ervice,
Comment Kwik Trip Inc.8/17
Inspection Fee $ 70.00
Occupancy Fee $ 10.00
Re-inspection Fee $
Total Fee' $ 80.00
Received By Manager on Duty
AN INVOICE OF THIS CHARGE WILL FOLLOW. DO NOT PAY FROM THIS FORM.
File Upload(for long
inspections)
Reinspection
Re-inspection# Date Time