HomeMy WebLinkAboutMy Dental_ASB Form Signed.pdfMayor
. •
Denis Law
Go.
Community & Economic Development Department
C.E. "Chip" Vincent, Administrator
AUTHORIZATION OF SPECIAL BILLING
Date: February 23, 2016
Address: 525 PARK AVE N, RENTON, WA 98057-5522
Description: UTILITY CONSTRUCTION FOR NEW MY DENTAL BUILDING R-3880
Permit: 015007909, ENG - Engineering - Construction
Project: PR15-003102
It is the
intent
of this letter to authorize the City
of Renton to bill the undersigned for all casts incurred
relative
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 .
. TIME AND MATERIAL COSTS INCURRED FOR SECONDARY, INDEPENDENT ENGINEERING
REVIEWS, CONSULTATION AND ON -SITE INSPECTIONS AS DEEMED NECESSARY BY THE CITY.
BILLING TO BE SENT TO: (Please Print)
Name:
Company
Address:
Phone:
Fax:
Owner/Developer or Authorized Agent Date