P - 79271- REQUEST FOR ELECTRICAL INSPECTION -
�%�] � Minnesota Board of Electricity �
^ 1 1�- 514 1821 University Avenue Suite S-126, Saint Paul, Minnesota 55104 � —'
(651)642-OBOOTIYlMRS1-S00-627-3529 www.electriciry.state.mn.us
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Request Date: Rough-in Inspection Required? O Yes �'f+lo Inspection Other Than Rough-In: ❑l�ady Now ❑ Will Call
Q�f ��/QL� You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arui hereby request inspecction of the electrical worlc at:
IN87RUC710N8 ON BACK OF YELLOW COPY BOARD OF ELECTRICffY CAPY � E&OOOQ1M79 8.7. 2w2