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• 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 TIME
DEVELOPMENT NAME (PROJECT) CONTRACTOR'S NAME CONTACT PERSON
STRUCTU RE ADDRESS (LOT/BLOCK) CITY, STATE COUNTY
NOTES ZIP CODE
TREATMENT TYPE/AREA
❑ FLOATING ❑ MONOLITHIC ❑ PATIO ❑ GARAGE ❑ DRIVEWAY ❑ STEM WALLIFOOTERS ❑ ADDITION
❑ CUTOUTS ❑ FOOTER ❑ FRONT ENTRY ❑ RETREAT ❑ BORA CARE TREATMENT ❑ PLUMBING CUT OUTS ❑ SIDEWALKS
❑ TAMP & TREAT ❑ TREAT ONLY ❑ FINAL ❑ POOL DECK q OTHER
PRODUCTS
❑ BASELINE
❑ OTHER
ACTIVE INGREDIENT
CONCENTRATION
❑ .C6% ❑ .1%
SQUARE FOOTAGE
O DOMINION 2LACTIVE INGREDIENT ❑ TERMIDOR SC ❑ BORACARF ❑ PREMISE ❑ TALSTAR
❑ IMIDACLAPRID ❑ BIFENTHRIN ❑ DISODIUM OCTABORATE TETRAHYDRATE
❑ .12% ❑ .25% ❑ .05% ❑ 23016 ❑ 9% ❑ OTHER
SQUARE FOOTAGE VERIFIED
❑ YES ❑ NO ❑ MEASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
❑ YES ❑ NO DETAILS
LINEAR FOOTAGE
GALLONSAPPLIED
"Certificate of Compliance"
As per 104.2.6, 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 m�
FINAL STICKER
❑ ELECTRICAL PANEL ❑ WATER HEATER
Payment Terms: Payment due at time of service.
Date
❑ OTHER
Applicator: (Evict A Bug Termite and Pest Control, Inc.)
Date
Customer (Property Owner or Agent)
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