P - 757641- 7 2 9-� 9 4� REQUEST FOR ELECTRI��� ,S�p�� �I��
Minnesota Board of Electriaty S fJ
1821 University Avenue Suite S-128, Saint PaW, Minnesota 164
(651)642-0800TTY/MRS 1-800�27-3528 www.electricitystate.mn.us
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�est �n Ir�edwf Requhed? L1 Yes Ir�p�tlon Other Than Raigh-In: �J�Ready Naw ❑ INf�I Cap
You m�t caD tlre Mspector when raedy! Date Ready. , ,� 1
I certlfy Uiat I am ihe CENSED CONTRACTOR ❑ COIV�AN1f ❑ OWNER and hereby requ�t ir�p�Uan of tl�e elechkxl work at:
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