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APPLj-]ATION AND CERTIFICATE- FOR PAYMLt J AIA DOCUMENT G702 PAGE ONE OF PACES <br /> PROJECT: St. Anthony Liquor Addition ARCHITECT: B IV B R Architects ap� / <br /> (name, address) <br /> 3 G� / <br /> ARCHITECT'S PROJECT NO: <br /> TO (Owner) City of St. Anthony CONTRACTOR: :f7�13 <br /> Pull.erton Lumber Co. ?16(81 <br /> M <br /> CONTRACT FOR: <br /> APPLICATION DATE: o2 9 APPLICATION NO: / <br /> ATTN: PERIOD FROM: J��y TO ,/ a l y 3/ <br /> CHANG'( 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 $ DE:DUCTIONS $ <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 /> Stdiw(luenl ChangeOrdcrs <br /> .f)nmhr:r Atltrrnved Net change by Change Orders . . . . . . . . . . :. . . . . . .$ <br /> (date) <br /> CONTRACT SUM TO DATE . . . . . .. . . . . . . . . . . . . . . . . i 63 ,wn <br /> TOTAL COMPLETED & STORED TO DATE . . . . . . . . . .$ / r 47450 <br /> (Column G on G702A) � <br /> 10'IALS RE:TAINAGE . . . .. . . . . . . . . . . . . . . . . . . .$ y s�39� <br /> Net change by Change Orders $ or as noted in Column 1 on G702A <br /> TOTAL EARNED LESS RETAINA(;E . . . . . . . . . . . . . . . . . .$ <br /> State of: County of: <br /> The undersigned Contractor certifies that Ilie Work covered by this Appli• LESS PREVIOUS CERTIFICATES FOR PAYMENT . . . . . . . .$ <br /> caliun for I'ayment has been completed in accordance with the Contract <br /> Dn(unienls, that all amounts have been pald by him for Wnrk !or 6: yi 475-Ss^2 <br /> previous Certificates for I'aymenl were issued and payments receive 'q)��` G(.ADYS-AliKAYM,ENT DUE .$ <br /> the f)%vner, and that the current payment shown herein is now du f .rmrr...miNNE O <br /> NOTARY PUB C LINTY <br /> Contractor: CiAF1VJ 1 ut ��Wlr)lrI 10 I 'berore me Ihis �% day of <br /> NAY Commleslon xp /f <br /> My Commission expires( �� <br /> By: ��/�i ` Date: <br /> In accor(lan with the Contract d this At plication for Payment the Contractor is entitled to payment in the arnount shown above. ❑ OWNER <br /> RCIIITECT <br /> Archileu: TCONTRACTOR <br /> This Cethficale is n egoliahle. It is ray. a only In the pa re narnOt he.reir and its issuance, payment and acceplance arc wilhnul preiudice to any rinhls of the Owner or <br />Contractor under their Contract. <br /> i <br /> AI.\ I)U \t(NT G702 • AI'I'11CAHON ANI) CI-R111'ICA.If. 10It I'AYMI'N'f • MARClj 1117 110N • AIA9 • <br /> r 1'111 �1 Arv1fR1(:AN I1,1ti1I11)1r ()f AR(:I1111,CIS, 1735 NIW YORK AVI'.,N.W., W,\tilll )N,I). C.20of16 , <br />