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Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC)104.2.6 and Broward County Chapter FBC 105.2.2)
PEST PREVENTION I FIRE ANT SERVICE I TERMITE SERVICE I RODENT EXCLUSION&REMOVAL I WHITEFLY TREATMENT
DATE OF SERVICE q- Z I 20. TIME I�l•t)l-2
DEVELOPMENT NAME(P�CT) CONTRACTOR'S NAME CONTACT PERSON
STRUCTURE ADDRESS(LOT/BLOCK) Cl ,STATE _ COUNTY
NOTES �< rfltt >i_ C — C C'S -U�,`7 ZIP CODE
c > 1 7
TREATMENT TYPE/AREA �
❑FLOATING IA`IONOLITHIC ❑PATIO ❑"GARAGE ❑DRIVEWAY ❑STEM WALLIFOOTERS UADDITION
❑CUTOUTS ❑FOOTER ❑FRONT ENTRY ❑RETREAT ❑BORA CARE TREATMENT ❑PLUMBING CUT OUTS ❑SIDEWALKS
❑TAMP&TREAT ❑TREAT ONLY ❑FINAL ❑POOL DECK ❑OTHER
PRODUCTS
❑BASELINE QIDOMINION 2LACTIVE INGREDIENT ❑TERMIDOR SC ❑BORACARE ❑PREMISE ❑TALSTAR
❑OTHER
ACTIVE INGREDIENT_ — —_ UiMIDArLAPRID ❑BIFENTHRIN ❑DISODIUM OCTABORATE TETRAHYDRATE
CONCENTRATION
❑.06% 9/1% ❑.12% ❑.25% ❑.05% ❑23% ❑9% ❑OTHER GALLONSAPPLIED
SQUARE FOOTAGE L1Q C) LINEAR FOOTAGE_
SQUARE FOOTAGE VERIFIED
0 YES ❑NO ❑MEASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
d3 fES ❑NO DETAILS
As per 104.2.6 FBC-If soil chemical barrier method for termite prevention is used.Final exterior treatment shall be completed prior to final building approval.
Certificate of Compliance:The building has received a complete treatment for the prevention of subterranean termites.Treatment is in accordance with rules
and laws established by the Florida Department of Agriculture and Consumer Services.(Per the Florida Building Code.)
If this notice is for the final exterior treatment,initial and date this line
FINAL STICKER
❑ELECTRICAL PANEL ❑WATER HEATER ❑OTHER
Payment Terms: Payment due at time of service.
:r
r
Date Applicator:The Bug Assassirls,•L C
Date Customer(Property Owner or Agent)
Planning &Development Services
S` J Building &Code Regulation Division
2300 Virginia Ave
o Fort Pierce, FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #."SV -26dS -05_�ZJOB ADDRESS: lSo7 V Qooa SP
BUILDER/CONTRACTOR: �,h
PEST CONTROL CONTRACTOR: vy 5 PEST CONTROL CONTROL LICENSE #: 756 ;L1 14 ei(,
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.
Square feet if area treated: Chemicals used: )�L)oll -C L
Percentage of solution: % Total gallons used:
Date of Treatment: -y-2C' Time of Treatment:
Footing Slab
is`Treatment V,st Treatment
Re-Treat Re-Treat
Driveway Pools
is`Treatment 1st Treatment
Re-Treat Re-Treat
Other Perimeter for Final Inspection
1st Treatment
Re-Treat i - 2 _2�
Signature of Extern ' for Date
Note. There must be a completed form for each required treatment 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
fee charged.
FSC104.2.6 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 copy for the building permit files The Treatment
Certificate shall provide the product used, identity of the applicator, time and date of the treatment, site location, area
treated, chemical used,percent concentration and number of gallons used, to establ/sh a verifiable record of
protective treatment. If the soil chemical barrier method for termite prevention is used, final exterior treatment shall
be completed prior to final building approval.
St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on
the electrical panel box cover, listing all the treatments and dates of applications.
Revised 7/24/2014