P - 80582REQUEST FOR ELECTRICAL INSPECTION F
Minnesota Boartl ot Electncity
� �-$$Q-$ j 3 �. 1821 University Avenue Suita 5428, Saint Paul, Minnesota 55104
(651) 642�0800 TTYlMRS 1-800-627-3529
www. electricity. sta[e. mn. us
� Itlen�ify the woB cmered by Uis request
THAN 50
I I�I II I�I IIII I IIIII IIII��III I�I
" 1 3 8 0 3 1 3 5"
ONE 8 TWO FAMILY DWE
Irklutles ihe Service andlor
,�
��sr
EACH UNIT
rotal fee is
29056
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FOR OFFlCE USE ONLY 10,��
OC
��56
II certi(y that I am the L%4 LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecAOn of the electrical work at
I Job Atltlress (Streeq Boz, or RoNe NoJ City Zip Cotle
License
OF
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