Form ID

Publication date

Location of premises

Certificate

Renovation/Addition to existing residence

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Michael Slocombe/Judy Byle-Jones
Address of Owner
Lot 26, Concession 11, Slabtown Road, Town of the Blue Mount
Name of Contractor
Patrick B. Coulter & Associates Inc.
Address of Contractor
20 High Street, Unit C, Collingwood, ON L4Y 3J6
Name of Certifier
Michael Slocombe
Address of Certifier
Box 53, R.R. #3, Clarksburg, ON

Identification of Premises

Lot 26, Concession 11, Slabtown Road, Town of the Blue Mountains, Ontario