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Planning &Development Services
Building&Code Regulation Division
2300 Virginia Ave
Fort Pierce,Fl,34932
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #: , 1 6a -QLi� JOB ADDRESS: �.�o ""i�' Ago m ,,ra-
BUILDER/CONTRACTOR:
PEST CONTROL CONTRACTOR: J& A ri&N -e c.
PEST CONTROL LICENSE #:
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: 3_b Chemicals used: Qfefhts&
Percentage of solution:._ tqi& Total gallons used: ca
Date of Treatment: Time of Treatment:
----Footing -- — - . - _ Slab
1t Treatment 11 Treatment- -- -
Re-Treat Re-Treat
driveway Pools
__V'Treatment 1st Treatment
Re-Treat Re-Treat
Other Perimeter for foal Inspection
1e Treatment
Re-Treat
Sign tore 6VExterminator
Note. There must be a completed form for each required treatment or re-treatment and this form mustbe on the job
site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a•re-inspection
fee charged,
FBC104.2.6 Certificate ofProtecdve Treatmentforprevention of termites: A weatherresistantjobsite posffng board
shall be provided 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 per flies The Treatment
Certificate shall provide the product used,Identity of the applicator,tlr a and date of the treatment,sitelocairon,area
treated,chemical used,percent concentration and number ofgallons used, to establish a verifiable record of
protective trsabnent, if the soil chemical barrier method for termite prevention is used,final exterior treatment shall
be completed prior to final 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.
• Termite Inspection Sus Chris* IS �0 772-323-7921
• Termite Pretreatment Je ra
E -A-Bu
• Pest Control 7 9
uict Toll Free: 1 -877-365-9990
• Rodent Service , Termite &
Pest Fax: 772-340-5990
• Fire Ant Lawn Service Control, Email: Evictabug@gmail.com
• Whitefly Treatment - Inc.
• Licensed & Insured LicJ131 5775 2373 SW Woodridge St.
() 3 Port St. Lucie, FL 34953
Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC)104.26 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 Y �C�-1 r., TIME q,l(�; �G1�� `-
DEVELOPMENT NAME(PROJECT) =CONTRACTOIRI'SAMECONTACT PERSON
STRUCTURE ADDRESS(LOT/BLOCK) CITY,STATE,ZIP CODE
COUNTY
0 NiL
NOTES,
!by o�t�3 .3e duan
TREATMENTTYPE/AREA S
❑FLOATING ❑MONOLITHIC ❑PATIO ❑GARAGERIVEWAY
LJ STEM WALL/FOOTERS ❑ADDITION
❑CUTOUTS ❑FOOTER ❑FRONT ENTRY ❑RETREAT ❑BORA CARE TREATMENT ❑PLUMBING CUT OUT ❑SIDEWALKS
❑TAMP&TREAT TREAT ONLY ❑FINAL ❑POOL DECK
❑OTHER
PRODUCTS
❑BASELINE ❑DOMINION 2L ACTIVE INGREDIENT ❑TERMIDOR SC ❑BORACARE Q PREMISE �' v
❑OTHER
ACTIVE INGREDIENT ❑IMIDACLAPRID ❑BIFENTHRIN ❑DISODIUM OCTABORATE TETRAHYDRATE
CONCENTRATION
❑.06°-' L3.12% LJ.25% L3.05% ❑23% LJ 9% OTHER 9% • / '
_ !6 GALLONS APPLIED
SQUARE FOOTAGE `1 LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
A3 YES ❑NO
MEASURED OR VERIFIED 1
PER PLANS
JOB READY CONDITIONS MET
YES ❑NO DETAILS
As per 104.2.6 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:Thalluilding 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
F
FINAL STICKER
❑ELECTRICAL PANEL ❑WATER HEATER ❑OTHER
Payment Terms• Payment due at time of service. `
_ir l..
Date Applicator:(EvictBug Termit a est Control,Inc.)
6'n S � :e
Date Customer(Property Owner or Agent)
�
BIL.ECRER r
o MC
OLOGIES
❑VISA "' . ..
S{>
0 AMEX
Ft.Pierce,Fkudda 34901
yds.ordered:
Time of job:
Customer Nerve" ,, , a, - j" -` Phone: r
r
City:
Pmojeed Name; P.O.#.
N $YMIKLIFESIGN PEA ROCK PRICE
USED RSG LIMP #57,M7 PER YD AMOUNT
F6MIX OTHER 1
1E TIME TIME, DEt.IVERY
0 STARTED FINISHED MPMGE
TRUCK
O.T.FEE
' SHORT�-Q
#1 1 O '"FREE_ L SURCHARGE
ming for every yard.
_ - 9tvlfpNMEIVi'AL
$1.00 per MinuWAfter
Sue TOTAL :: ►
TAX
TOTAL DUEj
REMARKS: r 4 A
�e
t� as�umons .slump rut a y of concrete when
t.ofiai ,whodt or water,or other'thaterIal requested on the job.
I,the undersigned,will assume aN responsibility for any damage where delivery is made
inside of the curb.
Customer X: Driver.
4W
Truck Number
ci
9
UOILECRE
❑MC
TE: HNOIOGIES
O VISA `
'. SRO
r
:466.50rR1 D AMEX
ft.Pierce,Florida 34981
Crate: e� t- —QY"V Cubic yds.ordered:
[-: Time of job: fh
Customer Naw, Phone:
City:
Project Name: _ P.O.#'
,YARD ESIGN PFA ROCK PRICE
USED REG UMP #067 PER YD J AMOUNT
�` �,,Ei ► �. "f ` tom::
FIBER MIX OTHER
TIIIIE TIME TIME. DELIVERY
N JOB STARTED FINISHED JHARGE
TRUCK
O.T.FEE
{
SHORT LOAi2 — J
\ _ 10 EL SUROWGE
,.lading for every yard. MVIR NMEWAL
$1.00 per Mirlu e-After sue rorAi.
t.. -
TAX i 4
TOTAL DUE
REMARKS: r yr �i ♦•_,
a Ab `[ 5•�,`�•
a-
r
P secaassumea#A resoonsibf ,slurd nd a i y of concrete when
gi o of t, __or water,or other' aterial requested on the job.
I,the undersigned,will assume all responsibility for any damage where delivery is made
inside of the curb.
Customer X: _Driver: j
�L
4
R` Truck Number.
�: f