P - 80587�
1-380-318
REQUEST FOR ELECTRICAL INSPECTION
�Minnesota 6oard of Elechicity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642�0800 TTYlMRS 1-800-627-3529
www. electr'rc"dy. state. mn. us
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I cedify ihat I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ �WNER and hereby request inspection of the electrical work at.