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HomeMy WebLinkAbout1636 W 4TH ST #715 INVOICE DATE , DUE DATE INVOICE# TOTAL DUE /Il 4 07/05/2018 08/10/2018 2019-00010009 $80.00 k Customer#: 6004 Please Make Check Payable and Remit To: City of Waterloo ATTN: 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#715 - 6-19-18 FOR BILLING INQUIRY: (319)291-4323 L Description Total Price j INSPECTION 2,000 $70.00 OCCUPANCY FEE $10.00 CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES 6004 07/05/2018 08/10/2018 2019-00010009 $80.00 Less Prepayment $0.00 Total Due $80.00 City of Waterloo Commercial Fire Inspection Report Inspection Number 1591 Prior Inspection 476 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* 1636 West 4th Street Business name Kwik Star#715 Inspection Date* 6/19/2018 Proprietor Chad Chizek Business Phone 319-234-0859 Email* dhafner©kwiktrip.com Email 2 SEservicedesk©kwiktrip.com Property Owner Kwik Trip Corp Emergency Contact Chad Chizek Information Phone 612-701-4076 Violations Ref# CODE Violation &Location Corrected 1 Remove obstructions, maintain a minimum 36"clearance to and around Furnace/AC 2 Repair egress light above condiments. Comments: ESD Ok Pumps 1 and 9 temporary OOS 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 Service Comment KwikTrip Inc 8117 Inspection Fee S 70,00 Occupancy Fee S 10.00 Re-inspection Fee S Total Fee* S 80.00 Received By Chad Chizek AN INVOICE OF THIS CHARGE WILL FOLLOW. DO NOT PAY FROM THIS FORM. File Upload (for long inspections) Reinspection Re-inspection# Date Time 1