P - 776631c REQUEST FOR ELEC� RI����T��
� rJ ��- 3 3 0� Minnesota Board of Electria
7821 University Avenue Suite S-128, ai Paul, MinnesoNa 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
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2�/Q � You must call the inspectw when ready!
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Date Ready: � �
I certify Ihat I am the I�CICENSED CONTRACTOR ❑ COb�ANY ❑ OWNER and hereby request inspection of the electrical work at: