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Planning Development Services
Building &Code Regulation Division
+ ' , 2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2172 Fax 772-452-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #:2,00-1- 0 Ll 3�L. JOB ADDRESS: l y A 0 t s A RA11
BUILDER/CONTRACTOR: F,rivt. & ,' 1a1
-PEST CONTROL CONTRACTOR: L6 e PLS 4- Il't11,1v
PEST CONTROL LICENSE #: -! [S a_-23--6
we,the undersigned, hereby certify that we have pretreated the above described construction for
subterranean termites in accordance with the standards of the National Pest Control Association.
�e feet
if Gam` � -3 0 Chemicals used: cO
Square feet if area tre ted:
Percentage of solution: CIC0 1 Total gallons used: f --
Date of Treatment: -2 f Z1-1.2 ) Time of Treatment:
Footing lab
1s`Treatment �.c_,1"Treatment
Re-Treat Re-Treat
Driveway _ Pools
1 t Treatment 15`Treatment
Re-Treat Re-Treat
Other Perimeter for Final Inspection
1t Treatment
Re-Treat
Signature of Extermin for Date
Note: There must be a completed form for each required treatments or re-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 will fail and a re-inspection
lee charged
n board .
FBC104.2.6 Certificate of Protective Treatment for prevention-of termites A_weather resistant jotr3ite pasts g
shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed,
providing a copy for the person.the.permit islssuedto.and.anoth er copy:f�r the brtl/dmg perm/t files The Treatment
Certificate shall provide the product used, Identity of the appCcator, Hme and date.of the treatment,site%atlon� area
treated;dieriJcal ucsed,percent rrdnhatran and number ofgailons used; to establish a t�erilrable;record of
protei ve treatment: If the soil chemical:bat4&method fnrtermite preevention ls:used, fina/error treatment shall
be completed prior to Mal budding approval.
St Lucle Caunty requires for the final inspection fra►r c0i.a Permanept Sticker to be placed®ra
;the eiecbical panet'box cover, listing all the treatments,and dates of applications.
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