Form ID

Publication date

Location of premises

Certificate

New outdoor pool

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
City of Kitchener
Address of Owner
200 King St W. Kitchener
Name of Contractor
MelloulBlamey Construction
Address of Contractor
700 Rupert St., Waterloo, ON
Name of Certifier
Jamie Lopes
Address of Certifier
40 Durward Place, Waterloo, ON

Office to which claim for lien must be given to preserve lien

200 King St. W., Kitchener, ON