1280 W Plaza FORM BD ELEV CERT& PEST FORM BOARD ELEVATION CERTIFICATE
DATE:
PERMIT
NUMBER: pes 7- v s9
ADDRESS: /z.5o lt//t3> �LAZ.A ST A?L�i✓rii3{.N `L/�
3,Z ?, 33
REQUIRED FINISH FLOOR ELEVATION ON CITY
APPROVED SITE PLAN: 5, 0
ACTUAL ELEVATION OF FORM BOARD OR
GRADE S TAKE: "9, 5
SURVEY COMPANY
NAME: Durden Surveying & Mapping, Inc.
1825-B 3rd Street North, Jacksonville Beach, FL 32250
(904) 853-6822 1 (904) 853-6825 FAX
SIGNATURE OF SURVEYOR:
Jacksonville
7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Er7e PS Brunswick
134 Newman Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
ecslimited.com
Work Order#: 71 4 l�
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#: +
Subdivision: 1-4` v L r , Reported to: -- Report#:
Unit or Parcel: Location By: Gauge#: �.
Lot#Block: Contractor: Date Tested:
Street Address: V--2 a City: �-'1 � r^—NTL "�-►�� ��
Method: ��'1 Course: fi
Material: 4-'-i�- Specific Requirements: y `�
Pass/ Elev/ Base/LR/ Dry Max.Dry %of Max Moist
Fail/ Location Depth Asphalt/
Retest /Lift Thickness Density Density* Density
*Source of Proctor(Project#and/or Work Order#)
P-Test Meets Specification Requirements F-Test Fails To Meet Specification Requirements R-Retest
To Be Completed In Field
- �-- Standby Approval
Employee Name /
Time Superintendent Printed Name
Start/Stop Travel Standby Job
Superintendent Signature
--------------------------------
(Office use)
ECS-10(rev.01/18) white copy-office use yellow copy-personal use pink and goldenrod-client use page—oJ_
Royal Pest Services, Inc
7011 Business Park Blvd
Jacksonville, FL 32256
PRETREAT WORKORDER ws
Date called In lh2&15 Date Scheduled 112 /
Time called in - Time Scheduled
yob Name
dab Address A14 ZA a 22
BiUi Name Nd�� w /
'i3jllitt Address a6 a� ZJ
Catled in : .� U Foreman on Site:
Notice of Inspection
and/or Treatment
Square footage called in: -
Actual Square Footage(By Treater) �/�!V _ Date of inspection
I
Lot&Block Number. - �ANiA4�N ?S 2.,-)/S
it ✓ Date of Treatrnent
Gate r}Tune Compteted: c1AN��'ti5 Z� , g D/g /�,'� �y ..�
—-r►�� c l�,,oerd -osyy
Slab Type' �C� /A(6- Peaticide Used
pesticide LtsV"idnG id Total Applied: Wood Destroying Organism Treated
Percent()Used: 00 Sign PPursuant to Chapter pter 482.228, Florida Statutes,this notice
required to be
Posted.Any licensee who performs control
any wood-destroying organism shall post notice of the sai
Treated By:_Zt StiCker Posted: treatment immediately adjacent to the access to the attic c
crawl area or other readily accessible area of the properl
treated.
XQQ �C
roxW awao.a�+cao su uaaon caa3p+aun U trow uroaCUM0".wit ,
6894 Phillips Parkway Drive N.
Jacksonville, FI 32256
(904) 886-2847
Fax: (904) 886-2847
www.royalpestservices.com