P - 78584�('� REQUEST FOR ELECTRICAL INSPECTION �
1�`t V�- 5 3 9❑4 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1-800-627-3529 www•electricity.state.mn.us
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Request e: Rough-in Inspedion Required? ❑ Yes InspeGion Other Than Rough-In: ❑Ready Now J� Will Call
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You must call the inspector when ready! Date Ready:
i certi(y that I am the I�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the elecficai woric at:
Job Site Address (Street, Box, a Route No.) CitY Zip Code
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License Number
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ire (Contra y a Owner Perfortning Installation) Phone (s)
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BACK OF YELLOW COPV BOARD OF ELECTRICITV COPV EB-OOOOtM74 8.1. 2002