Form ID

Publication date

Location of premises

Certificate

Tenant Fit-up for Extreme Pita

Date substantially performed:
Date certificate signed:

Participants

Name of Owner
Sean Black
Address of Owner
510 Earl Grey Drive, Kanata, ON K2T 1B6
Name of Contractor
Sean Black
Address of Contractor
510 Earl Grey Drive, Kanata, ON K2T 1B6
Name of Certifier
Sean Black
Address of Certifier
44 Elgin Street West, Arnprior, ON K7S 1N5

Identification of Premises

510 Earl Grey Drive, Unit 3, Kanata, ON K2T 1B6

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

300 March Rd., 4th Floor, Kanata, ON K2K 2C2