P - 79143REQUEST FOR ELECTRICAL INSPECTION
1� 7 2 5- 4 6 2 � Minnesota Board of Electricity �
r 1821 Universiiy Avenue Suite 5-128, Saint Paul, Minnesota 55104
{651) 642-0800 TfYIMRS 1-800�27-3529 www.electriciry.state.mn.us
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I certify ihat I am the $J LICENSED CONTRACTOR ❑ COMPANN ❑ OWNER and hereby �equest inspection of the electrical w�k at: