P - 75357Minnesot�t�e rtment of Labor and Industry
443 Lafaye oad North
St. f�aul, M ' S5155-4342
Phone: (6 284-5064
TTY/MRS� 651) 297-4198
www.ele city.state.mn.us
Cont actor Re uest for Elecirical In
Date � Rough-In Inspection Required? %f �
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t6on - One Famii Dwel��ssoc�ted Structure
Yes Single Inspection Other Than Rough-In: � R y Now
'�'� Contractor Must Schedule Ail Rou h-In Ins ections Contractor>Must Sched�le All Final Ins ections Will Schedule
Addr ss of In ection — S�:et CitylTownshi County
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Owner Name / Project Descrip on „_ �Oa ��,,,�j �'GG� �gl��� �
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Owner Telephone Number(s) — Include Area Code(s) „_. �/ �� �C�iy�r� e a
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Contractor Name Contractor Mailing Address S
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Contractor Telephone Number Contractor E-mail Address Electrical Utili� ���e��
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