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588 NW Mercantile Place Port St.Lucie, FL 34986
Office 772-879-0904 Fax 772-879-1116 Email:Service@CoastalPestControlFL.com
Certificate of Termite Treatment/ Soil Treatment
Permit# �/_L 1 Tl� Uri a Job Street Address 7LI S,�n a4 h << zr l lr
Job"City,State,Zip )E;c �TmP F�
Builder _Legal Description:Section Block Lot _
Soil Treatment Company Information
.Coastal Pest Control of the Treasure Coast Inc.
S88 NW Mercantile Place Port St.Lucie,FL 34986 "
D.A.C.S. License#JB5594/Certificate#8868
Treatment Information Second Treatment/Final
F.3d Treatment Date/Time / Treatment Date/Time
7_i Is 4- Chemical Used Chemical Used
�/► �(A Td Concentration Concentration
Gallons Used Gallons Used
Application Method Application Method
Linear/Squ re Footage / Linear/Square Footage
APPLICATOR%lGiqATURE
FBC104.2.6 Certificate of Protective Treatment for Prevention of Termites
A weather resistance jobsite posting board shall be provided to receive duplicate treatment certificates as each required protective
treatment is completed,providing a copy for each person the permit is issued to and another copy for the building permit files.The
treatment certificate shall provide product used identity of the applicator,time and date of the treatment,site location,area treated,
chemicals used,percent concentration,and number of gallons used,to establish a verifiable record of protective treatment.If the soil
chemical barrier method for termite prevention is used,final exterior treatments shall be completed prior to final building approval.