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r Building&Code Regulation Division
! ; 'NT 2300 Virginia Ave
Port Pierce,FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE,TREATMENT
CONSTRUCTION SOIL-TREATMENT
PERMIT 0ZW .JOB ADDRESS: 3 s'% fityj
BUILDER/CONTRACTOR:. 1'1;
PEST CONTROL CONTRACTOR :.S D,-,�i k r,-I cz-cz if ` s`77`. r
PEST CONTROL LICENSE #: �9 1.40�d
We,the undersigned,hereby.certifyrthat we have pretreated the above described construction for
subterranean termites in accordancewith the standards of the National Pest Control Association.
r Gl
Square feet if area treated: Chemicals used:: �-G'"�:�S. c 'k'Q
Percentage of solution: r -1 Total gallons used:
Date of Treatment: r7/ �I, Time of Treatment:
Footing Slab
1st Treatment 1-Treatment
Re Treat Re-Treat
Dnvew y Pools
1s'Treatment 1s'Treatment
Re-Treat Re-Treat
Other V Perimeter for.Final Inspection
1s`Treatment
Re Treat � �J _7/1 V/%(
.Signature of Exterminator Date
Note: There mustbe a completed form for each requlred ireatmentorre-treatment and this form mustbe on the job
site to be pfteed up bythe lnspeetorat time of each Inspection or thescheduled inspection will fail and a re Inspection
fee charged
FBC104.2.6 Certificate ofProtecfrve Treatment for prevention ofterrr lees A weatherre stantjobsite posting board
shall:be prWded to recelv!e dupilcate Treatment Certlticates as each iWuired protective&eatment is completed,
providing a copy for Me person the permit is/sued to and another copy for the bullding permitflles, The Treatment
Certificate shall provide the.product used;Identity of the appllcatur, time and date of the treatment,site location,area
treated,cierriicai used,percent concentration and number ofgallons used,to establish a.verifiable record of
protective treatment. If the sol/chem calbanfarmetlyedfor temhlte prevention is used,final exterlor tnsatrnentshall
be completed priorto final bullding approval:
St Lude-County requires for the final inspection for CO,,a.Permanent Sticker to be placed on
the electrical panel box rover,listing all the treatrvients and dates of applications.
Revised 7124(2014