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Planning &Development Services
Building &Code Regulation Division
a 2300 Virginia Ave
Fort Pierce, FL 34982
IN 11 772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #: JOB ADDRESS: 640 S'
BUILDER/CONTRACTOR: D d m C-or re-1(2
PEST CONTROL CONTRACTOR: EVICT-A-BUG TERMIT&PEST CONTROL INC.
PEST CONTROL LICENSE #: JB175775
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: DOMINION.2L
Percentage of solution: •05% Total gallons used:.
Date of Treatment: Time of Treatment:.;
Footing ab
1st Treatment t Treatment
Re-Treat ' `
Re-Treat;
Driveway Pools
1st Treatment 1sr Treatment
Re-Treat Re-Treat
Other Perimeter for Final Inspection
1st Treatment
Re-Treat
Signature of Exterminator ate
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.
FBC104.2.6 Certificate of Protective Treatment for prevention of termites A weather resistantjobsite posting board
shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed,
pro viding a copy for the person the permit is issued to and another copy for the building permit files The Treatment
Certificate shall pro vide 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 establish a verifiable record of
protective.treatment. If the soil chemical barrier method for termite pre vention 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
Termite Inspection e5U5 Christ is.�or 772-323-7921
• Termite Pretreatment 09 A-Buy a Toll free: 1-811:385-9990.
• Pest Control Termite & fex:112-349-5999
• Rodent Service Pest
• Fire Ant Lawn Service -- Control Email: Evictabug@gmail:com
• Whitefly Treatment ino- 4293 SW High Meadows Ave.
• Licensed & Insured Lic.JB175775 Palm City, FL 34990
Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC) 104.2.6, 105.10&R318.1 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 �;k AZ G TIME
DEVELOPMENT NAME(PROJECT) CONTRACTOR'S NAME CONTACT PERSON
r y'111 11 7 76"
STRUCTURE ADDRESS(LOT/BLOCK) )) CITY, COUNTY
G�/?li G,�1 )< �'u C%r For G s,
NOTES ZIP CODE
4,
TREATMENT TYPE/AREA
❑FLOATING b-MONOLITHIC ❑PATIO ❑GARAGE ❑DRIVEWAY ❑STEM WALUFOOTERS U.ADDITION
❑CUTOUTS ❑FOOTER ❑FRONT ENTRY ❑RETREAT ❑BORA CARE TREATMENT ❑PLUMBING CUT OUTS ❑SIDEWALKS
❑TAMP&TREAT ❑TREAT ONLY ❑FINAL ❑POOL DECK ❑OTHER
PRODUCTS
❑BASELINE ❑E?!pION 2LACTIVE INGREDIENT ❑TERMIDOR SC ❑BORACARE ❑PREMISE ❑TALSTAR
❑OTHER
ACTIVE INGREDIENT (❑-IMIDACLAPRID ❑BIFENTHRIN ❑DISODIUM OCTABORATE TETRAHYDRATE
CONCENTRATION
❑.06% ❑.1% ❑.12% ❑.25% 0:05% ❑23% ❑9% ❑OTHER GALLONSAPPLIED
SQUARE FOOTAGE YP r 1 LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
gyES ❑NO d-MEASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
OYES, ❑NO DETAILS
"Certificate of Compliance"
As per l04.2.6,105.10&R318.1 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.
J`�SplAllOughrrrgr�
Date Applicator:(EvictA Bug Termite and Pest Control,Inc.)
Date j Customer(Property Owner or Agent)
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www.evictabugpestcontrol.com