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OW4U: QffotOtono1111 lfo«m Ro«d South Oyiulltr.MN SS52S TRojlcr;Oroiiu Ck)r llnll/rulkv •ml PuUii Wuiki Uuililiiig Am II AIION NOriKiim lo Pkojlicri NO ;IhtitbutkHi lo: n OWNERflOMOONmCTOR:OOKnUCTPOR:Mukahy Drywall VUARrjini f;Boai iiufi Kj<»u$ Pfiwcf Ttl Nuiih Srcund SirrciMifinrAfMilii. KLN mN'PR.AC.T DATE:f~l ARCHITECr f~| CONTRACTORCONTRACTOR'S APPUCATION FOR PAYMENT <br />AppRcUloft It Mtdc Idc rtyincQl, it thown below, In (onncciloo %rfih the Conirtci Conilnuatlf^ii Sheet, <br />AlA D ocummi CTOSt It attached <br />I OUCMALOOKTRACTSUM 165.000 00 <br />Ihe underiignrd ContrAcior ceiilfirt (Itai lo ihf U*m uf the roniraiiuf't knowledge, <br />informaiion and belirf the Woik c<ivrrrd hy this Application for Payment has been <br />completctf in accordance with the C^ontraci Dociiinenis. that all amounts have been <br />paid by the Contractor for Work for which previous Ortificaies for Payment wTre <br />issued and |*ayrnems received from the Owner, and that current ^>aytnent sitown <br />hciciti is now due. <br />Net chanf c ky Ghange Or den.....____16,911 00 CONntMTroR: Mulrahy Drywall <br />S OOKTRACTSUMTOIMTE (Une I CE).> •• ••• •• ••••• •* »• «181,91 MX) <br />lUie: <br />tOTAL OmirLmD C nOREOTO DATE 181,911.00 <br />itTAlNACe: <br />a.€sf Completed Work <br />(ColiMna D li E M CTOS) <br />Suie of: <br />(ktunty of: <br />Subscribed and sworn to before <br />ma this day ol <br />of Stored Material <br />(Colum F on CTOS) <br />Toial Ktialnagf (line %a E SB or <br />Tool bi Colunia I of CTOS). <br />Nouty Putlic: <br />My Commission empires <br />R TOTAL EARNED LESS RETAINACE. <br />(Um 4 Ictt line t Total) <br />181,911 00 <br />LEM PREVIOUS CERTinCATES FOR PAYMENT. <br />(Um S btxn prtot CettMcaie) <br />ARCJIITECT'S CERTinCATE FOR PAYMENT <br />In accordance with the (a»ntract I>ih unieius. based on on site csbaervations and the <br />data comprising the above application, the Architect erruAes lo the Owner that lo the <br />iKSt of the Architect's knowledge, information aruf belief the WcHk has progressed ai <br />indicated, the quality of the Wtul is in actordame wiih the Cotiiiaci Documents, and <br />the ( A.nifstiMr is entitled to payment of the AXlOUNf Ck.KllMk.D <br />CUBBIKT PAYMIKT Dirt <br />RALANCX TO FINISH, PI US RETAINAGt <br />(Um S Icit Line 6) <br />• sssss»«a»« »»»•••••• <br />I /^^//.rvSia»roo AMO jvr (iJuiniD.*****••••*«••I <br />(AlUik M^<inari#M ^ mmmtfU cetti/sW dtffmt ftmm tW mmmtnt fm <br />ad/igum m lAii A^ptu^m* «nd #n tht Cmhnumiim SUtf cSaf mt ikassgwf tm <br />€0m/mm fa ik# amaunf imuf%sd } <br />CT V iOi ADDrtkW <br />iPRiigt Ofdtn §pp tmt4 bi <br />mmAom <br />R n TC m <br />d tkia Month* <br />Tocali <br />ckanga bf Qtangt Orders <br />DEDirenONj Ak(4iriiL(:i <br />Dure: <br />lids Ornfcaie is not neg.mable The A^fOUNT CEKTUliD is payable only to the ' <br />Coniracior named herein Itsstame. payment and vcepance of paymem are wiih«»ui <br />prejudice to any riglits of ihe (twner *>t rV*niracfor under this Casntiact <br />•• HffucnnoNAkmcjmrHnTi loa rsyvtiKfisti tDnfuN*AiA*tMi'iHi amcrkan iNsim/tt oi saciirTitii ms niw w>aa avtni i nw <br />»c itaaani • wumwHk u.nw.aaaw—Msa w>y«rt las cmi»9a