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i~'PLICAT?C~N A~~tl CcRTIFIC~TE ~ ~~R F'A'tMEh~T <br />~D fO~JPdER~: lMARIOt~ CUUtd?Y <br />id~Q~ NIGH ~T. tJE <br />~ALE~4~ t~~; ~ i s f {~ <br />FNllM (CONTRACrDR): STATON CQt~STRtlCTFOhi, INC. <br />~9s'94-A Airport Road <br />fugene„ OR 974~+~-9594 <br />PHONE #: Si41? 4E1-C~S~,~ <br />CHNtd[~E Cs1tDER SIIMf+'~kY <br />PRQJECT: MARIOIV CO!SA! EM/DEhiQ <br />c^~0 HIGH "aT. <br />5ALEM, UR 47sIQ~ <br />~., PAGE ? <br />AGPLIL'ATIQN N0: 7 D~TE ~!E0;'_It4"r <br />F'ERIQB ?0: ~c81c.1`~' <br />VIA iARCHITECT}: <br />CtNVTRACI FaR: <br />I ADDITION5 { DEDUCTI~ I <br />GH~NGE tlRbERB flP~'R4UED IN i I I <br />~REVIDUS MUNTNS AY QWtJER I I I <br />' i { <br />Ai~GRGVED 7HI5 MONTH -- I__ -..'~ I l <br />NI~MAER <br />I 1 I <br />I DATE Ar~RRQV~Tr~i i I <br />I ~ I I <br />I I I I <br />f I I I <br />I I 1 I <br />I i I i <br />i 1 i I <br />i { ! I <br />I I f I <br />_ ___._____ TOTALS I ~l 1 <br />i 1 I <br />CdET CHAN~E i I I <br />BY GHRNGE DkDER9 I I 1 <br />I I I <br />The ur~dersiqned Cantractc~r LFY`~Ii1g5 that tn the best of the <br />Cc~ntr•actor°s knawledge, inforeatiuri and belief the work <br />rc~~rered by tt~is Application fer-~ F{ay~er,t has been ca~pleted ' <br />in accordance with the Contrart Docueents, that all a~ounts <br />have been paid ~y the Contractor fr,r work for which previous <br />Certificates for Payeent were ~s~ued and payeents received <br />from the Owner, and that currer~t ~,ay~ent shown herein is now <br />dP.ie. <br />CQ~d1kACTttR• /~' <br />B~/:~ ~ Date: ~~~~G~ <br />~~ ~"~,~.~~----- <br />AFCFiITECT'S CERTIFiGATE FUR R~YMENT <br />ir. aceur~dance with the Contract Dncu~ents, based on an-site <br />ot,~er~vation~ and the data cae~,rising ttre a~oae applicatian <br />the Architect certifies to the 4wner that tn the hest of the <br />At~chitect's knowledge, inforeatiar~ and belief the Work has <br />~+ragreJsed as indicated, the q~aaiity of the Work is in <br />accGrdance witt~ the Contract Do~u,ents, and the Contractor <br />is entitled to pay~ent of tt~e flMDUNT CERTI~IED, <br />ARCHITECT'S <br />F'ROJECT (V0: <br />CONTRACT DA?E: <br />DRICFNAL C~ITRACT SUbI 5i8, 5i9. Q~B~ <br />NET CHAN6E BY CHAN6E ORDERS <br />GONTk~T SlMll TO DATE 5i8, `79, I~0 <br />T4TAL C~IPLETED RND STORED TQ DATE ;18, 574, Q-g- <br />RETAItSAGE: <br />S.~X nf Cnipleted Wark 518,579.~ <br />;.~~ of ~tared Material <br />Total Aetainage ~5,~:'A.9~ <br />TCiTAL EARNEIt LESS RETAINAGE 49~, 650. 05 <br />LE5S PREVIIXIS CERTIFICATES ~ PAYMEN7 458,673.4~~j p <br /> ~ <br />$ <br />CURRENT 5ALE5 TAX: c4i ~ <br />C7 <br />~ <br /> ¢ g <br />~¢ <br /> <br />~.Q~X of Taxable A~ount u <br />Q u <br />~ >' m ~ ¢ <br /> ~a~a~ <br />Current Sales Tax ~ ~'~- `~ ° <br /> oU~~~ <br />F~~ <br />CUARENT PAYI~PlT DUE s:i~ 972. Q~5 Z`~ o <br />~ <br /> <br /> ~ <br />AALANCF T~-FI~1I _SH, IIdCL.U-ING RETAINflGE 25, 9;'.8. 95 ~ ,,~~ <br />/ ~/ vr, ~ . . :7 / / ! ~ , L ~ . / e~iF=~x~~d <br />State ~f: QJt,eqon Cnunty of: ~ J~- (____ <br />Sub~cribed and ~worn to before ee ttFis~g~ ~ay of~Sf 1?q7 <br />My Gn~~i~sion expires: ~.a -~{ q 9 <br />AMDUNT CERTIFIED E <br />ARCHI3ECT: ,~ ~Q~~(~ U (,v~ ~ . <br />By~~`~~~01~~ {~~e D~t~. g /~~97 <br />This Certification i~ not negat~ahle. The AbIUUNT fCERTIFIED is <br />paya~,re flnly to the Gontr~actar- nasett herEir~. Issuance, pa~rsent <br />ar~d ~cceptance of paV~ert are without ~i~e.judice to any ri4hts <br />af tt~e ~wner ar Contractor under th}¢ Contrac` ~` 1~`~ 5 <br />.~ `~`,,~v ~ --~~~ : GU-~,~L -tZ,.. .i • <br />o[~-- J~ i~ ~( ~.~ I^.f -~{-~ ~S2- ~j(/~ Y a/f r; O-~, - <br />~ V <br />~~~ ~7 <br />~`~ <br />