P - 76177REQUEST FOR ELECTRICAL INSPECTION
1- 5 51- 6 2 4� ��nnesota Board of Electricfiy
1821 Univers(ty Avenue Suite S-128, Saint Paul, Minnesota 55104
(851) 642-0800 TTY/MRS 1�00-627-3529 www.elecbicidystate.mn.res
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��C' You must ceA the irope�.tor when readyl Date Ready. .
I certify tt�t I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER ar►d he�eby requ�t ir�pection of ihe electrical work at: