HomeMy WebLinkAbout301 W 4TH ST INVOICE DATE DUE DATE INVOICE# TOTAL DUE
05/26/2021 06/30/2021 2021-00000251 $80.00
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Customer#: 14788 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
RISQUE' 715 Mulberry St
301 W 4TH ST WATERLOO, IA 50703
WATERLOO,IA 50701
Amount Enclosed.
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION-301 W 4TH ST-4-3 0-21 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
14788 05/26/2021 06/30/2021 2021-00000251 $80.00
Less Prepayment $0.00
Total Due— $80.00
City of Waterloo
ATERLOO FIRERESCUE I V 4P-Tent°°
INSPECTION REPORT
RISQUE GENTLEMAN'S CLUB,301 W 4TH ST,BLDG 301 W 4TH ST, WATERLOO IA 5070241461;,00
DETAILS
Inspection Date:04/30/2021 1 Inspection Type:Annual Inspection(1 Yr) I Inspection Number:4504 I Shift: N/A Station: N/A
Unit: N/A 1 Lead Inspector:JEFF SIEBEL I Other Inspectors: N/A I Fee:$80.00
VIOLATIONS
No Violations Found
GENERAL NOTES
JEFF SIEBEL-05/03/2021 @ 11:17 annual inspection$80
JEFF SIEBEL-05/03/2021 @ 11:18 Maintain a minimum of 36"clear path through basement between exits.No other
violations noted at this time.
NEXT INSPECTION DATE
04/30/2022
CONTACT SIGNATURE
mirzet Dizdarevic �[
Signed on:05/03/2021 @ 11:18 G `�
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on:05/03/2021 @ 11:18
Printed on 05/03/2021 @ 11:19
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