HomeMy WebLinkAboutMy Dental_ASB Form.pdf AUTHORIZATION OF SPECIAL BILLING
Denis Law
Mayor
Community & Economic Development Department
C.E. "Chip" Vincent, Administrator
February 23, 2016Date:
DescripƟon:
Address:525 PARK AVE N, RENTON, WA 98057‐5522
UTILITY CONSTRUCTION FOR NEW MY DENTAL BUILDING R‐3880
Permit:U15007909, ENG ‐ Engineering ‐ ConstrucƟon
Project:PR15‐003102
TIME AND MATERIAL COSTS INCURRED FOR SECONDARY, INDEPENDENT ENGINEERING
REVIEWS, CONSULTATION AND ON ‐SITE INSPECTIONS AS DEEMED NECESSARY BY THE CITY.
It is the intent of this leƩer to authorize the City of Renton to bill the undersigned for all costs incurred
relaƟve to the referenced project, by the City of Renton for the following work :
TIME AND MATERIALS FOR ANY AND ALL ROAD CLEANUP EFFORTS PERFORMED BY CITY
FORCES OR CITY CONTRACT.
ALL OVERTIME FOR INSPECTION AND RELATED ACTIVITIES, BILLABLE AT A RATE OF SEVENTY
FIVE DOLLARS ($75.00) AN HOUR.
TIME AND MATERIAL FOR ANY WORK DONE BY CITY STAFF TO REPAIR DAMAGES .
BILLING TO BE SENT TO: (Please Print)
Name:
Company:
Address:
Phone:
Fax:
Owner/Developer or Authorized Agent Date