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/1I'AATION AND CERTIFICATE FOR PAY001 AIA DOCUNIENT C702 PACA OF PACIS <br /> PROJECT: CHITECT: 13 W 13 R Architects <br /> (name, address) • <br /> St. Anthony t110n y Liquor Li Addition (� <br /> ARCHITECT'S PROJECT NO: <br /> TO (Owner) City of St. Anthony r CONTRACTOR: Fullerton Lumber Co. <br /> CONTRACT FOR: <br /> � . <br /> APPLICATION DATE: —d' �.9IS� APPLICATION NO: I c►^o, <br /> ATTN: PERIOD FROM:!& i" Ises I TO r ^a <br /> CHANGE ORDER SUMMARY Application is made for Payment, as shown helow, in connection with the Contract. <br /> Conlinualion Sheel,AIA Document G702A, is attached. <br /> Change Orders approved ADDITIONS S DEDUCTIONS 1 <br /> The present status of the account for this Contract is as follows: <br /> in Previous months by <br /> Owner— <br /> TOTAL ORIGINAL CONTRACT SUM . ... .. . . . .... ... . .....E 2881P500.00 <br /> 5uhsr(µnrnl ClrangeOrtlers <br /> 00 <br /> 1`8111111 ml Approved Net change by Change Orders . . .. . . . .... . ... ....E 15 <br /> r(latel <br /> I Io <br /> a �aS�8'7 lfl 9 3°O CONTRACT SUht TO DATE . . . . .... .. ... .. . . ...... <br /> 3 lalaa,ls-) a 4 b q°O 00 <br /> 'i 11a-7 88 5 50°O 1 TOTAL COMPLETED & STORED TO DATE . ... . .. ...E 89T 15 <br /> 5 +1 a9 88 �� (Column G on G702A) <br /> TOTALS RETAINAGE % . . .. . .. ... . .. ... ...... ..E <br /> Nei change by Change Orders S —4— or as noted in Column 1 on G702A <br /> TOTAL EARNED LESS RETAINAGE . .. .. .. ...... .....E A9,_J fS <br /> Stale of: County of: <br /> The undersigned Contractor cerlilles that the Work covered by this Appli• LESS PRF:V10Q -CERTIFICATES FOR PAYMENT ... .. ...E C 79��6a� <br /> cation Inr 1`aymeni has been completed In accordance with the Contract <br /> i)ircumenls, that all amounts have been paid by him for Work for which -6; `o <br /> previuus Certificates for I•aymeni were Issued and payments received from CUlpit.q� ti�1'Y�Mt N,T'pf�E .... ..4 Y-7 .... .... <br /> ncv owner. and that the current payment shown herein Is now due, <br /> .� O .► u <br /> ,:��u�i rJh�r(ltrtil;'livpf/5i to before me this /'6 (lay of <br /> Contractor: 1 <br /> �® Ci` i <br /> J ' <br /> ebo �•�.1Ij;�`tpimiislon empires: <br /> Ily: Date: <br /> In accordance wish ll onlracl . I is App is 'on for Payment the Conlraclliris'cnlilled to payment in the amount shown above. ❑ OWNER <br /> 0' -IITECT <br /> Architect: ❑ CONTRACTOR <br /> ❑ <br /> fly. ❑ <br /> This Certificate is not r,ntlAh►e. II Is,I iyAhl nnly In the payee named herein and Its Issuance, payinent and accemance are without weiudice to any righls of the Owner or Conleaclor <br />under their Contract. <br /> AIA DOC►1.111NT 6707 • AI'1'11CAT10N AND C1.111111CAlf. I()It PAYh11NT • AIAIICII 11171 11)1110I4 • AIAO <br /> '•1 1'171 • 1111 AnllltlCAN IN%III1Jlf Of AK(:11111.1.15, 1775 NI.W YORK AVr:.,I•I.W.,WASI111•I(;I()N,I). C.711nm ( •-• <br /> e <br />