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2 (Instfuclions on rcvcr5C ciHo) O^t or,GE application NO; OisirlbuliTWO (2) DOWN!PtRIOD TO: Q ARCHI7/31-8/24’ DCONTARCHITCCrS OPROItCT NO: DCONTRACT DATE; ^ ^lymcnl, as shown below, In connection wHh the Docutliffil G763# is tilt ached.....................................»5^oo_STORED TO DATE...................* 40.960.0 0,-OT) <br />cd Work $ 4,096.00_^--------- <br />» C70T) <br />^terial %--------- <br />■03) <br />5« + 5bor ^ 4,096.00 <br />5 Total) <br />nnCATESFOR 6,440.00 <br />fctom p,.o. C.rtita.1.)...............;,n.424.00 <br />u,' ,roiNA(;t;;;::; ujisjs <br />JO___________________ _____________—- <br />County of: <br />lo before fW this <br />.....................................................%------------------------- <br />differs from the amount ipplio <br />_____ _____________ n.ile: —-----— <br />ner.oi ihle The AMOUNT CtRIlFIfD is payabk <br />em h'uaote, payment and accrplance^ofpaymei <br />IS ti( the Owner or Contractor under this Contra <br />CONTINUATION SHEETAIA Oocumeni G702. APPLICATION AND CLRTIFICAIE FOR PAYMENT, containing Coniraclor's signed Certification is attached.In tabulations below, amounts are stated to the nearest dollar.Use Column I on Contracts where variable reiainage for line items may apply.AIA DOCUMENT C703 (Inslrurlinns on reverse side) page or P acisAPPLICATION NUMBER:TWO (2)APPIICATION DATE: 8/24PERIOD TO: 7/31-8/24 ARCMIIECT'S PROJECT NO:A B c 0 E F c H 1lUMinSCRlPTION or WORK sciiniuiEi)WORK coMPinro MATERIALS KT7AL %BAIANCE RETAINACENO.VAlUt IROM PRI VIOUS AmiCAIION (Dr [)IMIS PfRIOD PKtSINIlY SIORED (NO! IN 0 OR E)COMPl E HD AND STORED lO DATE (Dr Erf)G + C)TO IINISM (C - Ci)i).PUBLIC WORKS STRUCTURAL STEEL $ 1,020.00 $1,020.00 -0--0-$1,020.00 100 -0-$ 102.002).MISC. STEEL $ 6,225.00 $2,625.00 -0--0-$2,625.00 42 $ 3,600.00 $ 263.003).CITY HALL STRUCTURAL STEEL-$14,240.00 $1,573.00 $12,667.00 -0-$14,240.00 100 -0-$1,424.004).STEEL JOISTS $ 3,365.00 -0-$3,365.00 -0-$3,365.00 100 -0-$ 336.005).METAL DECK $ 870.00 -0-$870.00 -0-$870.00 100 -0-$ 87.006).MISC. STEEL $ 3,100.00 -0--0--0--0-0 $3,100.00 <br />7). <br />POLICE BUILDING <br />STRUCTURAL STEEL $14,240.00 $1,573.00 $12,667.00 -0-$14,240.00 100 -0-$1,424.00 <br />8).STEEL JOISTS $ 3,365.00 -0-$3,365.00 -0-$3,365.00 100 -0-$ 336.00 <br />9).METAL DECK $ 870.00 -0-$870.00 -0-$870.00 100 -0-$ 87.00 <br />10).MISC. STEEL .$ 3,100.00 -0--0--0--0--0-$3,100.00 <br />11).BONDS <br />* <br />$ 365.00 $365.00 -0--0-$365.00 100 -0-$ 37.00 <br />"7l5(r.oo 4o^(io.oo <br />MA OOCUMINT C7M * AITIICAIION AND ClRIirirAtl fOK lAtMiNt • MAY fWI l()ltH)N • AIA* • C I'WI <br />111! AMIRKAN INSIIIUIl Of ARCMIltCIS, 1715 NIW Yl^KK AVINUI. NW. WASMINGION, DC 2Vn^G703-I^J <br />.JiL__J <br />Tl