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Planning &Development Services
Building&Code Regulation Division
S 2300 Virginia Ave
Fort Pierce,FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
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PERMIT #;_..2011-0538 JOB ADDRESS: 1382 Nettles Blvd, Jensen Beach, FL
BUILDER/CONTRACTOR: Five Star Mobile Homes
PEST CONTROL CONTRACTOR: Patrick Exterminatin
PEST CONTROL LICENSE #: 4864
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: 900 Chemicals used: _ Cyper TC
Percentage of solution: .25% Total gallons used: 90
Date of Treatment: 1/15/21 Time of Treatment: 10' 0
Footing Slab
1'Treatment x i�t Treatment
Re-Treat Re-Treat
Driveway . Pools
I't Treatment it Treatment
Re-Treat Re-Treat
-Other _ -Perimeter for Final Inspection
l"Treatment
Re-Treat . "I -•���115/21
Signature of Exterminator Date
Note_ there must be a completed form for each requlmd 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 inspect/on w///fal/and a re-Inspection
fee charged
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FOC 104.2.6 Certificate of protective Treatment for prevention of termites A weather resistant jabsite posting board
shall be prov/ded 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 riles The Treatment
Certificate shall provide the product used,Ident/ty of the applicator, time and date of the treatment,site location,area
treated, chemical used,percent concentration and number ofgal/ons used, to establish a verifiable record of
protective treatment. If the soil chemical barrier method for termite prevention Is used,final exterior treatment shal/
i be completed pr/or to Anal 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 7/245014