Green Building Construction Payment Application
Project Information
Project Name
Project Address
Owner
Contractor
Application No.
Period To
Payment Summary
Description
Amount
Original Contract Amount
Approved Change Orders
Adjusted Contract Amount
Total Completed & Stored to Date
Retainage
Previous Payments
Current Payment Due
Balance to Finish
Sustainable Construction Details
Green Building Standards (LEED, BREEAM, etc.)
Environmentally Responsible Materials Used
Signatures
Submitted by
Date
Approved by
Date