P - 79494REQUEST FOR ELECTRICAL INSPECTION ��
- I �" jI � � � � � �-. Minnesota Board of Electriciry �
1� 1 � 1821 University Avenue Sui[e 5-128, Saint Paul, Minnesota 55104 �I
` �' � '*'� (&51) 642-0800 TTY/MRS 1-800-627v'529
www.electrdcity.state.mn-us ��
Itlemiy ihe wark caveretl 6y this request: �' n� �� ��� �__ ^,�. _
—/ vL 1't?"if L(L
.LYflEW ❑REMODEL ❑ADDITION ❑REPAIR .__ __ . _
Includes me Service anNor Power SuNpty up to 500 Amperes, NI
Cirnids anA Two Insoection Tnos Each Dwellinq Unil �$6(
FON OFFICE USE ONLV
I If I III IINI Illlf IIIlI IIIII IIIII IIIII I IIII IIII Illl
3[ 1 1 3 9 1 6 2 O?E
tolal iee Is
s�a�eC:
��9qs� �5,��'
� � �— w—�r � �o� m�, ��� �ne ���o, �,� ree�� � Date ReeQy I
I cerlify ihat I am the �LICENSED CONTflACTOR ❑ COMPANV ❑ OWNER and hereby request inspection et ihe eledrical work at:
Jab Hedress (StreeL Bax. Or qoute No.l CiN 2in f.atle
� Mailing
Fire No.
Perlorming
Phone
Number
i���LS�1 �7/,/%�rII������r%/��r����