P - 82492REQUEST FOR ELECTRICAL INSPECTION
1J �� � ��� � Minnesota Board of Electricity
� � � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
` (651) 642-0800 TTY/MRS 1-800-627-3529
, www. electricity. state, mn. us `'�'
FOR OFFICE USE ONLY
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Reques[ Date: Rough-in Inspection Reqwrea'! U res V rvo mspe
, O'� I$'O � You must call the inspector when readyl Date
I ceRily that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
Job Address (Street, Box, or Route No.) City
55 �'1`�''` � �ric� 1
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�chical Contrador / Company Name
DEPENDABLE ELECTRIC. INC.
I Coon Rapids, MN 55433
(Authorized Signature (CoMracto ny or Owner
Contractor
Phone
Than
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and hereby request inspection of the electrical work at:
Nixnber
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