Form ID

Publication date

Location of premises

Certificate

Addition to rear of existing building

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Ajax Property Maintenance
Address of Owner
855 Westney Road, Ajax Ontario
Name of Contractor
Orlando Mazzatta
Address of Contractor
Same as Owner
Name of Certifier
Aldo Riva P.Eng.
Address of Certifier
489 Kingston Road W. Ajax ON

Identification of Premises

Part of Block ‘D’ Plan M-26 Part of Lot 10 & 11 Ajax - Reg Plan M-1175.