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PAY ESTIMATE NO. rt'na
TO 1-4\1`n TP(AcAC•' ' Cko.Ja ',n' CDBG NO.
(Contractor)
EXPENSE CODE
ADDRESS 323K+ /-\ e •
DATE OF BILL 1 2 ' 510
a-rerlos It . SOr)o3
INVOICE NO. c6 3Dri
OWNER Li s We 4 o- k ap.
ADDRESS 15 Mint R —
CONTRACT DATE 'hew I a cio 6
SUMMARY OF PAY ESTIMATE
ORIGINAL CONTRACT SUM $ AGC1
CHANGE ORDER NUMBERS $ V\I o,
TOTAL CONSTRUCTION COST $ )(3GG •
LESS AMOUNT PREVIOUSLY PAID $ 1) 3 o
BALANCE STILL IN CONTRACT $ 2,0 —
PAYMENT REQUESTED $ aG --
LESS 10% RETAINED
TOTAL DUE CONTRACTOR THIS ESTIMATE $ �_
I have made a progress inspection of the property being rehabilitated at the above address.
The construction work for which payment has been requested has been satisfactorily
completed in accordance with the construction contract.
0 (.0 • c--tAj\-
DATE REI-f*BILITATION SPECIALIST
APPROVED FOR PAYMENT
1 VI 14 L-
BATE COMM t DEVELOPMENT DIRECTOR
OR DESIGN: E