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Planning &Development Services
Building&Code Regulation Division
0 2300 Virginia Ave
® Fort Pierce,FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #: JOB ADDRESS: 5� � `► n D�
BUILDERJCONTRACTOR: Rebd oov�cx4c-
PEST CONTROL CONTRACTOR: .c.�nties C j wdl m
PEST CONTROL LICENSE #; )S9� 5 9.4
We,the undersigned, hereby,certify that we have pretreated the above described construction for
subterranean termites in accord ince with the standards of the National Pest Control Association. -
Square feet if area treated: yi Chemicals used: i ols�
Percentage of solution: Total gallons used: 43CdE dh t
Date of Treatment: Time of Treatment: m
Footing x Slab
is'Treatment —%-_ist Treatment
Re-Treat Re-Treat
Driveway Pools
1't Treatment ., it Treatment
Re-Treat Re-Treat
Other I Perimeter for R l Inspection
I'Treatment
Re Treat
Signature of ExtedFinator Dat
Note: There must be a completed form for each required treatment orre-treatment and this form must be on the job
site to be picked up by the inspector at time of each inspection or the scheduled inspection W11 fail and a re inspection
fee charged.
FBC104.2.6 Certificate of Protective Treatment for prevention of termites.. A Weather resistant jobsite posting board
shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed,.
providing a copy for the person'the permit is issued to and another rnpy for the building permit fries The Treatment
Certificate shallprovide the product used,identity of the applicator,time and date of the treatment,site locabon,.area
treated, chemical used,percent;concentrat on and number ofgallons used, to establish a verifiable record of
protective treatment. If the soil;cheij�icalbaaler method for termite prevention Is used,final exterior treatment shall
be completed prior to final building approval
St Lucie County requires foe the final inspection for CQ,a Permanent Sticker to be placed on,
the electrical panel box cover listing all the treatments and dates of applications.
Revised 7!2412014