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Signature CONTRACTOR INSTALLATION Business name CCB license no. Print name last edited 5/5/2017 BJones MDI license no. 3 Surcharge 12. 12 x total equal to 1 or 2 Name Qty. Cost each 4 State administrative fee for only OAR 918-500-0105 5 30. 00 b Reinspection no. of hrs. x fee per hr. 93. 00 CATEGORY OF CONSTRUCTION Residential Government Commercial JOB SITE INFORMATION AND LOCATION Job site address City County State ZIP Subdivision Space/lot no. Reference Taxlot DESCRIPTION OF WORK Year...

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