Form ID

Publication date

Location of premises

Certificate

Installation of Municipal Services in Annabelle Place, City of Hamilton.

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Jim Zaborsky.
Address of Owner
c/o A.J. Clarke and Associates Ltd., 125-155 James Street So
Name of Contractor
J.B. Underground Services Ltd.
Address of Contractor
1776 Lakeshore Rd., Selkirk, ON N0A 1P0.
Name of Certifier
A.J. Irani, P.Eng.
Address of Certifier
125-155 James Street South, Hamilton, ON L8P 3A4.

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

Attn