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ARf' ATION AND CERTIFICATE FOR I'AYN *T AIA DOCUMENT G702 PAGt*rOF PAGES <br /> PROJECT: ARCHITECT: B W g R Architects,(Warne, address) St.. Anthony Liquor Addition <br /> ARCHITECT'S PROJECT NO: <br /> TO (Owner) City of St. Anthony CONTRACTOR: Fullerton Lunber Co. <br /> • •., <br /> CONTRACT FOR: <br /> APPLICATION DATE: ) OL�v 1 APPLICATION NO: <br /> 1 �- <br /> PERIOD FROM: P/?� ! TO I OI 301; t <br /> ATTN: I I � ( . <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 E DEDUCTIONS S The present status of the account for this Contract is as follows: <br /> in previous months by <br /> Owner— <br /> TOTAL ORIGINAL CONTRACT SUh1 . .. . . . . . . . ... ... . . .. . .$ 288,S00.00 <br /> Subsequent ChantleOrders <br /> Number Appr(jvrd C)C7 <br /> relate) Net change by Change Orders . . . . . . . .. ... . . . . .. .$ <br /> CONTRACT SUM TO DATr. . . . . . . . . . . . . . . . . . . . . . . .$ <br /> TOTAL COMPLETED & STORED TO DATE . . . . . . . .. .$ <br /> (Column G on G702A) <br /> TOTALS RETAINAGE E-2 % . . . . . . . . . . . . . . . .. . . . . .. . .$ �1 S c! <br /> Net change by Change Orders $ or as noted in Column I on G702A <br /> TOTAL EARNED LE L AINAGE . . . . . . . . . . . .. .. . . .$ <br /> Slate of: County of: )?` <br /> The undersigned Contractor certifies that the Work covered by tills Appli- LESS I'RI--VI .( f'RCAYES FOR PAYMENT . . . .. . . .$ 1 <br /> calion for Payment has been com p Ieled in accordance wish the Contract, ° <br /> Dnrumenls, that all amounts have been i,ald by him for Work for which �•� two y e� <br /> evious Certificates for I'aymenl were issued and payments received from Itr-�Jd+,�1v`_ �Ta`D_LhE�. . . . . . . . . . . . . . . . . .. . . . . . .$- <br /> the pr .� <br /> Owner, and that file current payment shown herein is now due. V " <br /> SuH�cr 07w,weir o before me Ihi 3G day of el. <br /> Cr)nlraCl <br /> ss` tar itilit: <br /> on to expires. <br /> fly: DaIc: v LJ b •./��. w� / �r C�/ <br /> In,accordanccwilh ll�e�Contr t and chi Application for Payment the Contractor iS'enliticd to payment in the arnount shown above. ❑ OWNER <br /> Architect: <br /> El <br /> ❑ CONTRACTOR <br /> This Certificate is I negoliahle• ayahle only to the payee named herein and its issuance, payment and acceptance are without prejudice io any rights of the Owner or Cnnlrartor <br />undr.r Ihr.ir Contract. <br /> AIA D0r.UMf.NT 6701 • AIT11CATION AIJU CI.RMACAlf 101( 1'A1•MINT • MAIR(:11 11171 H)HI )N • AIA4 <br /> '•) 1171 • fill AMIRICAN INSIIIMr: Of ARCHIILC'IS, 1775 NI.W YORK AV[:., N.W.,WASIIINGMN,1). C.211011(, I <br /> A. <br />