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P - 84565IIII�II IIIII IIIII IIIIIIIIII IIIII IIIII IIIII IIIII 8E°�� ess °A e Rm° sR�AS'Pa P MNT5° ��� :� � 0 2 9 9 3 6 8 1* � ' ' � . Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other: D er Ran e Elec. Heat Tem . Service "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. Agl�q S-- � Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Ofher Fee # $ervice Enha Sae Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 00 Amp; S'� ' 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps TransformedGenerator INSPECTOR'S USE ONLY TOTAL $ign/Outline Ltg. Xfmr. �, S�O Alarm/Remote Contro Swimming Pool (� I7 ereb certi thaf I ins cied }he eledric I' stallation described herein on the tes �fe(f � / Irrigdtion Boom Rough-�n � Dare � __ Speciallnspedion -�`-'�--� –='�6—r Final Investigative Fee .� — THIS INSTALLATION MAY BE ORDERED DISCONNE D IF NOT COI�IPLETED WITHIN 18 MONTHS. 2 9 9- 3 6 8� OFFICE USE ONLY This request void 18 monMs from validation date printed in this box. � - r\ PLEASE PRINT OR TYPE �°�3 ��J Request DaM` Rough-in inspection iequired2 �s � No Inspecfion Other Than Rough-In: eady Now � Will Call � 'C � ' � � (You must call ihe inspedor when reody� Date Ready: � � / � —7 I, ❑ licensed contractor � owner hereby request inspedion of the above electrical work ot: Job Address (Street, Boa, Route N � City Zip Code � %2 � }�'y�i� �' � I � -C Lj�� 3 Z_ $ection No. Township Nome or No. Range No. Fire No. County �� Vcc� ant Phone No. -P,✓V �- t 1 Gt. ru ' 3'3-.S Power $upplier ^ Address �l � I J Eleciriwl ConfracTor (Compony Name) C Li ans N Master Lic. No. (Plant Moiling Addross (Conkador or Owner Perfortning Insfollafion) Authori ignature (C trpdor or O n erfortning Installafion) Phone No. � �p . EB- A-10 6/95 STATE BO D COPY - SEE IN UCTIONS ON B OF YELL COPY