P - 79604� REQUEST FOA ELECTRICAL WSPECTION
�� 13 9-171 E Minnesota Board of Electricity
1821 Univeretty Avenue Suite S-12@ Saint Paul, Minnesota 55104 -
�� PI ."�,.,'gx:. (651) 642-0800 TTY/M(iS 1-800$27�529 �.
J wrvw�.electncito.stare.mn.us '���
IAentity the work covereA 6y this request ��` ���� �� � �
B�W ❑REMODEL ❑ADDRION []REPAIF
OF
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lnclutles the Service aMlor Pvxe� Supply up to 500 Pmyeres, A6
Circutls antl Two Insoectian Tnos Each Dwelling Unit �$BC
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FOp OFqCE USE ONLY
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� i���V u�ID I I �ou must cali �he inspatlor when readyi � �ate ReaOg I
I cetlify that I am the �LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of tl�e electncal work at:
dab MWress (Street. Box, oi FoNe No.) CIN 2io Code
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BORflO OF EIECTHILIIY GOPY
VELLOW CaPY