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AP[ _-ATION AND CERTIFICATE FOR PAW._. J AIA DOCUMENT G702 PAGE UNE OF PACES <br /> PROJECT: ARCI IITECT; <br /> (nan'ie, :d(c, ;s) St. Anthony Liquot Addition B W B R Architects . <br /> ARCHITECT'S PROJECT NO: J $ <br /> 'ro (Owner) City of St. Anthony CONTRACTOR: Fullerton Lumber Co. <br /> CONTRACT FOR; <br /> APPLICATION DATE: APPLICATION NO: —( <br /> ATTN: PERIOD FROM: I 17D)3 g TO <br /> CHANGE ORDER SUMMARY Application is made 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 /> subsequent Chanl;eorders ' <br /> ;lurnbrr Approved <br /> (dale) Net chan);e by Change Orders . . . . . . . . . . . . . . . . . . .$ <br /> I l0 1 � 8� r� bh3 <br /> 01 Log a SUM TO DATE . . . . . . . . . . . . . . . . . .. . . . .$ �`� I r •r=) 1-s <br /> TOTAL. COMPLETED & STORED TO DATE . . . . . .. . . . A35- 6 <br /> (Column G on G702A) <br /> TOTALS 00 RETAINAGE �%. . .. . . . . . . . . . . . . . . . .. . . . . .$ c - �/ 7` � <br /> Nei change by Change Orders $ or as noted in Column I on G702A <br /> TOTAL EARNED-K-5S RETAINAGE . . . . . . . . . . . . . . . . . .$ ;'-233r' <br /> Slate of: County of: <br /> The undersigned Contractor certifies that the Work covered by this Appli- LE c�� RTIFICATES FOR PAYMENT . . . .. . . .$ L� <br /> cation for Payment has been completed in accordance with the Contract �. �\�ta �� ` <br /> Dnrumenls, That all amounts have been (raid by him for Work for which cj G'" N ",p% " <br /> previous Certificates for Payment were issued and payments received from P fdN `�UE ,$. l <br /> the Owner, and that the current payment shown herein Is now due. l jO PA �Q,<05 . <br /> -_Yk <br /> �� yl �5 �3e��LCd and sworn to before me 11 //�day of �jjr��, 19 <br /> Cunha \ r; � / <br /> MVP rNulary'Prnbbc: � � J. 6Ltat.t/ <br /> r 0 <br /> Z jrrr�- My Commission cxpir s: ih a✓ �y y� <br /> Dale: <br /> In accordance with ile Contract and this Application for I aymenl the Contractor is enlilled to payment in the amount shown above. ❑ OWNEF, <br /> Architect: ryj ARCHITECT <br /> ❑ CONTRACTOR <br /> ny: 1� ❑ <br /> This CeuiGcarr. is not ne,r Liable, It is ayahle oily In the payite named herein and its issuance, Isayrnl till acceptance are without prejudice to any rights of the Owner r❑ir <br />Contractor under Iheir Contract. <br /> A I A 1)0(U,\IINr G7r12 V AIIIIII('ATI( IAN (711t111'lCAIr I()1t VAYkiINT • MA ItCI1 1')71 1'l)IIION • AIA ) <br /> ^� 1971 . Ill) AhilkI :AN INS711111E O Cllllt(.IS, 173, NI,W Y1)lil: AVE., N.W.,WASIIIN(;rON,U. C. 21)1)04 1 <br /> s <br />