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APF _ATION AND CERTIFICATE= '.FOR PAYN. _- J AIA DOCUMENT G702 P GL OF <br /> PROJECT: ARCHITECT: <br /> (name, address) St. Anthony Liquor Addition 13 W 13 It Architects <br /> ARCHITECT'S PROJECT NO: <br /> TO (Owner) City OF St. Anthony CONTRACTOR: �W <br /> Fullerton Lumber Co. <br /> CONTRACT FOR: L ' 1:61 V a r v" <br /> APPLICATION DATE: g/a �/� APPLICATION NO: a <br /> ATTN: <br /> PERIOD FROM: g'l I °� TO <br /> CHANGE ORDER SUMMARY Application is inade for Payment, as shown below, in.connection with the Contract., <br /> Continuation Sheet,AIA Document G702A,,is attached. <br /> Change Orders approved ADDITIONS $ DEDUCTIONS $ <br /> in previous months by The present status of the account for this Contract is as follows: <br /> Owner— <br /> TOTAL ORIGINAL CONTRACT SUM . ... .. . .. . . .. . .. . . . . ..$ 288,500.00 <br /> Subscrluenl Change Orders <br /> Numb;r Apprr)vrd , <br /> Irlaic) Net change by Change Orders . . . . . . . ... .. . . . . . . .$" <br /> CONTRACT SUM TO DATE . . . . . ..•. . . . . . . ... . . . . .$ <br /> r <br /> TOTAL COMI'LETF:D & STOKED TO DATE . . . . . .. . . .$ <br /> (Column G on G702A) <br /> TOTALS RETAINAGE % . . . . . . . . . . .. .. . . . .$ <br /> Nei (hange by Change Orders S t)r as noted in Column I on G702A Ue„® <br /> .TOTAL EARNED LESS RETAINAGE .. . . . . .... . . . ... .. ..$— � - - ��'�'. <br /> State of: County of: <br /> The undersigned Contractor certifies that the Work covered by tills Appli• LESS PREVIOUS,gift FICATES FOR PAYMENT . .. .... . .$ <br /> cation for Payment has been completed in accordance with the Contract <br /> Documents, that all amounts have been paid by him for Work for which , oaf°'�(�SSOAP ply <br /> previous Certificates for Payment were issued and payments received from cult ��U��7 .:.... . . . .... . . . .. . . . . . . . .. .$ �' ��® / /�{ <br /> dre Owner, and that the current payment shown herein Is now due. ° s. ' <br /> o° �alcass� gApl �sw lrcl3$lo cc me This�/s, 22�ay ofc 19�1 <br /> Cr)nlrJClnr o <br /> � - ......�hR)Q��ptll- ��A. ,� <br /> Kpires: <br /> Date: <br /> In accordance with the-onlra this )plication for Payment the onlract is ed to payment in the amount shown above. OWNER <br /> Architect: / ° ❑.ARCHITECT <br /> ❑ CONTRACTOR <br /> � p <br /> ny. / a� 0131r187 � O p <br /> This Cer ' ' ite egntiah e. It is P. able only to the payee named herein and its issuanc yment and acceptance are svitho prejudice to any rights of the Owner(ir CnniraLj&under <br />their Con: <br /> AIA 1)0 11.NT (702 • AI'1'11CAT1ON AND (I.Rfll l(:Arf IOR PAYMI'NT MARCH 1471 . HON • MAO <br /> r') 1971 • 'fill AhifRICAN M111111f: Of ARC11111.C'IS, 1735 NLW YORK AVE..N.W.,WASI1INGrr)N,1). C.2006 <br />