P - 80039l REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Eleciricity
� 1-382-146 � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
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www.electricity.state.mn. us
FOR OFFICE USE ONLY
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' 1 3821 467" 2/A�Q� �'Sp
ry�em uain: Houghtin Inspecfion Requiretl? ❑Yes ❑ Inrpection Other Than Rough-in: ea�1y Now � Will Call
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I ceRify that I am the �i LICENSED COMiRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work aY.
Jab Atltlress (Slreet, Hox, or Route No.) Ci�y Zip Cotle
e^A^^ 4655 `. 2 1/2 ST NE FRIOLEY 55A21
Company
I Mailing Atltlress (COn�rador. Company or
Company or
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License Number
BOARD OF ELECTRICITV COPY INSTqpCTIONS ON 9ACK