Form ID

Publication date

Location of premises

Certificate

Addition & Renovatios

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Pierson’s IGA
Address of Owner
279 Wellington St., Wellington, ON K0K 3L0
Name of Contractor
Cornerstone Builders Ltd.
Address of Contractor
199 Front St., Suite 555, Belleville, ON K8N 5H5.
Name of Certifier
Owner
Address of Certifier
As owner

Identification of Premises

Lot 121 Plan 47R-4421