P - 79491REQUEST FOfi ELECTRICAL WSPECTION ���
-�-13�� 15 9 ; Minneso[a Board of ElectriCiTy �
1821 Universiry Avenue Suite S-12fl, Sa1nt Paul, MinneSOW 551�4
7 ? ' '"' (651) 642-0800 TTYlMFS 1-800-627-3529
� ivww.electrtcity.stafe.mn.us
Idemify tAe work coaeretl �y ihis reques�: ./ � /y �� �, G�..� n
�EW ❑REMOOEL ❑ADD�TION ❑REPAIR��Vt_` �' —�� "� � " '
� ALARM,
OF LESS
ONE 8 TWO FAMILY DVJELLINGS, EACN UNIT
!ncludes ihe Service anNor Power Supply up to 500 Amperes, All
Cimuik aM Two Insoection Trios Fach Owellina Unit � 38L
total fee is
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FOfl OPRCE USE ON�Y
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� i L-4V -��[i1D1 I �ou must ca0 me Inspecmr wnen reatry! I Oate Reatly: I
I certity ihat I am ihe �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec[ion of the electrical work at:
Jah Adtlress (S�reet, Boz, or Route No.) CiN Zin Cntlu
� Occupant
]/t/2JOp
Phone
License Number � Mester Licanse