HomeMy WebLinkAbout306 PARK RD 'INVOICE'DATE DUE DATE INVOICE# TOTAL DUE
06/15/2021 07/30/2021 2021-00000307 $80.00
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Customer#: 4009 Please Make Check Payable and Remit To:
City of Waterloo
ATTN: City Clerk/Accounts Receivable
PARK ROAD INN 715 Mulberry St
306 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-306 PARK RD-5-11-21 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
4009 06/15/2021 07/30/2021 2021-00000307 $80.00
Less Prepayment $0.00
Total Due—* $80.00
City of Waterloo
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SPECTION REPORT06(
PARK ROAD INN,306 PARK RD,BLDG 306 PARK RD, WATERLOO IA S0703
DETAILS
Inspection Date:05/11/2021 I Inspection Type:Annual Inspection(1Yr) ; Inspection Number:4573 I Shift: N/A = Station: N/A
Unit: N/A Lead Inspector:JEFF SIEBEL I Other Inspectors: N/A
VIOLATIONS
No Violations Found
GENERAL NOTES
JEFF SIEBEL-05/12/2021 @ 07:43 keep obstructions and combustibles 36"away from furnace.
JEFF SIEBEL-05/12/2021 @ 07:43 annual inspections$80
NEXT INSPECTION DATE
06/13/2022
CONTACT SIGNATURE
brenda aldrich
Signed on:05/12/2021 @ 07:41 e
INSPECTOR SIGNATURE
JEFF SIEBEL
Signed on:05/12/2021 @ 07:41
Printed on 05/12/2021 @ 07:44
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