HomeMy WebLinkAbout315 PARK RD INVOICE DATE DUE DATE INVOICE# TOTAL '.IlUE
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/,,, ,�\CIlk 06/15/2021 07/30/2021 2021-00000298 $80.00
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Customer#: 4437 Please Make Cheek Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
HICKORY HOUSE 715 Mulberry St
315 PARK RD WATERLOO, IA 50703
WATERLOO,IA 50703
Amount Enclosed:
DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
KEEP THIS PORTION FOR YOUR RECORDS
COMMERCIAL INSPECTION-315 PARK RD - 05-26-21 FOR BILLING INQUIRY: (319)291-4323
I
I_Description Total Price J
INSPECTION 2,000 $70.00
OCCUPANCY FEE $10.00
CUSTOMER# BILLING DATE DUE DATE INVOICE# CHARGES
4437 06/15/2021 07/30/2021 2021-00000298 $80.00
Less Prepayment $0.00
Total Due $80.00
City of Waterloo
WATERLOO FIRE RESCUE �P �oo
'
__INSPECTION REPORT -� ,�
/ HICKORY HOUSE,315 PARK RD,BLDG 315 PARK RD, WATERLOO IA 50703 i L) 41
DETAILS
Inspect' n Date:05/26/2021 1 Inspection Type:Annual Inspection(1Yry Inspecti Number:4654 1 Shift: N/A Station: N/A
Unit: N/ Lead InDctor:JEFF SIEBEL 1 Other Inspectors: N/A 1 Fe $80.00
VIOLATIONS
No Violations Found
GENERAL NOTES
JEFF SIEBEL-06/01/2021 @ 08:54 annual inspection$80
NEXT INSPECTION DATE
05/27/2022
CONTACT SIGNATURE
Tim Chilcote . c .J /
Signed on:06/01/2021 @ 08:53 /�C lQ�
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on:06/01/2021 @ 08:53
QUESTIONS ABOUT YOUR INSPECTION?
JEFF SIEBEL
Jeff.Siebel@Waterloo-ia.org
3192301224
Printed on 06/01/2021 Ala 08:54
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