Form ID

Publication date

Location of premises

Certificate

Alterations for: CT - Temporary Location

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Pembroke General Hospital Inc.
Address of Owner
705 Mackay Street, Pembroke, ON K8A 1G8
Name of Contractor
Boudens Building Systems Ltd.
Address of Contractor
116 Chamberlain Street, Pembroke, ON K8A 2M2
Name of Certifier
Ronald A. Awde, Architect
Address of Certifier
1458 King Street, PO Box 142, Bethany, ON L0A 1A0

Identification of Premises

201 Deacon Street, Pembroke, ON K8B 1A4

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

c/o Mr. Lloyd Koch President & C.E.O. 705 Mackay Street, Pembroke, ON K8A 1G8