P - 78604REQUEST FOR ELECTRICAL INSPECTION
1� 4 21 � O� o � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
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14210306
est Dete: Rough-in InspeGion Required? ❑ Yes
—1 C� �Q 3 You must call the inspector when ready!
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inspedion Other Than i2ough-In: ❑
Date Ready.
s-�'�d
Call
I certiy that I am tl�e �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec6on of the elec6ical wak at: