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, <br />OWNER - � <br />ADDRESS <br />CONTRACTOR ..–r <br />� c <br />INVC�ICE & REQUEST �OR PAYMENT <br />COMMUNITY HOUSING IMPROVCMENT PROGRAM <br />CITY OF EVERETT, WASHINGTON <br />� S.��Gy�S . REOUESTp <br />� _ .1 f_ �d�`�. � - " j - <br />. d , :7 ✓ � .n � � / ` `.� i..P i l DATE � r:� <br />I7EM DESCRIPTION <br />NU!dOER OF WORK <br />� rriJ'— <br />_�� �i—%>iS <br />� '' /-` �b�r / <br />< [ „ i .��a <br />� <br />.:! �C'-- /�C' <br />� r7 �' � �' i <br />� -- � <br />' Y7�'<} <br />� T <br />V' �� % ��n �? � � <br />, - ��)I i� � <br />Gi '�� r:.�Er� L'�'O i� nlrr�cR <br />CONTRACT <br />AMOUNT <br />U <br />// �%. L�� / <br />�� — � � //>' ' � . <br />, !t%`C'%-'r '`.t�(� . :�/C �.�1 � f//�'"l <br />.; p <br />% PAYMENTS <br />COMPLETE TO DATE <br />/� <br />k <br />THIS <br />REOUEST <br />_ �i <br />� <br />�/ <br />SUB•TOTAL " `X � J . 55 <br />�TAX Fil%,�7 <br />�A�7�� II��AYTAI�GNDCD TOTAL, �'%�6./2 <br />FOR PROGRESS PAYMENTS. RETAINAGE OF 10%SHALL BE DEDUCTED: � q3, �. <br />OR. FOR FINAL�{�YMENT, ALL PRIOR RETAINAGE SHALL BE ADDED: <br />' AMOUNT D�E THIS REOUEST �Q -?, J-r"'� <br />• � � r' r � l <br />.y ��' � -,�_ . , - � <br />.r / <br />. . ,.j'!� � �/c_. l �' ��t_t��>�.�_� <br />CONiRACTOR'S'SIGNATURE `"� �� HOUSIN PROVEMENTADVISORI�NSPECTOR <br />.. {� <br />,� WHITECOPY—CITY • YELLOWCOPY—OWNER • PINKCOPY—CONTRACTOR <br />