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HomeMy WebLinkAboutPermit Worksheets PLANNING AND DEVELOPMENT SERVICES DEPARTMENT Building and Code Regulations Division 2300 VIRGINIA AVE. ' - FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST PERMIT NUMBER: S d/ ADDRESS: ff©Z ze (a V"1 am requesting that the above permit be renewed. I understand that I must schedule and pass all required inspections for the permit to be finaled. Further,I understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a passing inspection during any six month period during the renewal period. Justification (-W t 2 /G OWNERBLDR R CONTRACTOR SIGNATURE DATE Print Name 'TF FL CO T�OY OF ACKNOWLEDGED BEFORE ME THIS DAY OF -1-2016- B 2016_ BY Y\I�1 V`J 1`11 YV�� WHO IS PERSONALLY KNOWN TO ME ,OR HAS PROVIDED AS IDENTIFICATION. !STATE :nounty f I r KAREN S. NIELSEN =�Fnr nye( : Commission# FF 115637 SIGNATURE OFROTAIty SE �= o�c My Commission Expires June 12, 2018 IIII IIFF FOR OFFICE USE ONLY: Number of Open Inspections: Total Inspections: (Divide open by total to get%of open inspections) Percentage: Original permit fee: x%open = $ Renewal fee Example: [15 divided by 23=.65(0/o)] $175(permit fee)x.65=$113.75(renewal fee) Revised 6/24/2014 RECEIVED 01/07/2015 11:55PM Jan 11 160411p P•1 Planning&bovelopment Services - _ auilding&Code regulation Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-2172 Fax 772,^462-6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERMIT #.' 125M . JOB ADDRESS: L BUILDERJCONTRACTOR: PEST CONTROL CONTRACTOR: PEST CONTROL LICENSE #: cam Sri Sz We,the undersigned,hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the Nationai Pest Cont I Association. 1G�C� Square feet If area treated: Chemicals used: Percentage of solution: 6-)•C�Oe Total gallons used: SCJ Date of Treatment: Ti of Treatment: �� QcJrg n rootingV Sla Treatment 15 Treatment Re Treat Re"Treat Driveway —Pools ase Treatment 1s`Treatm t _Fte-Treat Other P9 menalInspection 15C Treatment Re-Treat 7 ,�a/'41r— Sign' re bf Exterminator Oate Nate: There must be a completed fmm for each required treatmetrt or re-treatment and this farm must be on the job site to be picked tip by the lnspectnr at dme of each inspection or the sclodured Inspection will tai!and a te-Inspedlon fee charged. FBCi"2.6 Cerdflcate of Pratectim 77eatrnent for prevention of 4a=2-es. A w.eatber resistantPWLe posting board shall be provided to receive duplicate 7reatmenf Ceranotes as eao' required protective treatment fs completed, providing a copy for the person the permit is issried to and anotiw copyfor the building peo mit 0w The Trmtrlerrt Cb-W7cate shall provide the product used,identlty of die applicator,time zhd date of the treatment,site lavation,area treated,chemical used,percent conGL°gmfton and number of gallons used, to establish a verifiable record of larotectfve tr-atmerJr, ifnP1e soil chemlcaf barrier metfrad For termite prevention is used>pnaf exterior tmatmentsWll be comple&d pilar to final bullifing approval. St Lucia Courrty requires for the final inspectJon 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