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Planning&Development sety!ces 0 2013Building&Code Regulation:Division2300 Yrrc�whi Avety, Permitting
< f , fort:Pierce,F 34982,
772-462-2172 Fax 772=462-i6443
CERTIFICATE OF TERMI'
TSTREATMEW
PERMIT#•SLR G 7//` 041'gl 30B ADDRESS¢ jcifg6.-/
BUILDER/CONTRACTOR � L LLB
PEST CONTROL CONTRACTOR:
PEST CONTROL UCF-NSE #: ' _f,
We,the undersign4 hereby certify that we have pretreated the above described wnstruction for.y subterranean termites in accordance with the standards of the Mat.ionat Pest:Control Association.
S Square feet of area treated: SChemicals used:
Percentage Hof solution: Total gallans.used: 6
r6
Date of Treatment: �� :1 L 53 Time of Treatment: 5•
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P Treatment treatment
Re:Treat Re-Treat:
✓Driveway Pools,
5 1�Treatment f st Treatment
Rey-Treat Re-Treat /
sS Other Perimeter for l=tnal Ir:spect%on: (0/ c Aug
1�'Treatment
Re Treat
Signature of Exterfffinator Date
y . Mfe: Themn7ustbe a rnmpfeWform for eadh requ/redbeahnentof.rL-hwiment and fliisform must-be c
site to fie pfdced Up'AYIfte irrspectOrat Me ofea&kveeffan Of[fie sdvdvledinspecb'orr wil/fall and a re-
fee charged.
' FBC104.2.5 Certf,ffcate of ProtecMfe Thep fwMt-for prevention of ferrnites. A a#?er reslslantjobslfe pc�sb
shall Lie provider/to receive duplicate Treatment Cer4ffrcates as each required pratedim:i aftmlerrf is rrrF!e
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z providing a copyforthe person ibe permitisissued ib and anothercVpyforthebul/dirmg permitfiles fie 7r.
Ce filf/caie shaJ/provide-me prod used,Identllyoft/ie appllcalza><tirrle a gate ofthe trea6n&7� /cam
treated chemlcal used, ,percentmncenfrdtfan and numberofgallons aced in establish a wjiflable m=mrl al
profect}ve treatment If the soil chemical bankrmetirod for fermlte pmvenflan.:Is used,final ortenor treatm
lie completed pride to.final building approval
St Lucie County reciuires fior- te_i�renal i�aspection br CO a=Pern�anent Sticker to be'p be
�0409e v'scal p nel box cover,likting.all the a ents an- elate of,-Opplicatiom
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manning & Development Services
Building & Code Regulation Division
p 2300 Virginia Ave
® Fort Pierce, FL 34982
772-462-2165 'Fax 772-462-64 F�FlI,F
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Request for 30-Day Temporary Power Release
Date: • Permit Number: 171 I•
Project Address: �Q/o S MM6LER Kbi . f. PIERCE- FA.
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1. This temporary power release is requested for the above stated purpose only, and there will be no
occupancy of any type, other than that permitted by construction during this time period.
2. As witness by our signatures,we hereby agree to abide by all terms and conditions of this agreement,
including Building Division Policy, which is incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled"Requirements for 30 Day
Power for Testing"have been fulfilled and the premise is ready for compliance inspection.
4. All requests for an extension beyond 30 days must be made in writing to the Building Official stating
the reason for the request. Power may be removed from the site and/or a Stop Work Order issued if
the Final Inspection has not been approved within 30 days. A fee of$100.00 will be required to lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
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OWNER I A E DATE
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GENERAL ON CTOR SIGNA URE OATE
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ELE CAL CONT CTOR SIGNATURE DATE