P - 76304� REQIIEST FOR ELECTRIC�IN� �� 10� ���'
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-� -- -. 1821 University Avenue Suite S-128, Sai t ul, in ta 5 °-�
' (651) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us "` "�
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'�� Rough-in Inspedton Required? ❑ Yes (�lo In.specdon Otl�er Than Rough-In: � Ready Now � Call
S/1J — �/ You must caU the inspector when readyl Date Ready:
I ceitiiy that I am the �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechic�l work at
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