P - 79473REQUEST FOR ELECTRICAL INSPECTION
1 18 0 8 2 0 Minnesota Board of Electricity '° -
�� � 1827 U�Nersiry Avenue Suite 5-128. Saint Paul, Minnesota 55104
(651) 642-0800 T1YlMRS t-8U�-627-3529
www.eleciricity.state.mn.us
Itlentlry the wark cavered Ly tnis request: h ie� /J�� ept���_ �ypr /�G C�l _ OR / � h C �
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� pNEW ❑REMO�EL ❑ADDITION
Inclutles the Service and�w Power Supply up to 500 Amperes, All
n,.��n� ��n r,�,. i������� Trins Each Dwallino UnM �$&
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FON OFFIGE USE ONLY
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Vou must rell Ne inspecto� wM1en reetly! Date Reatly /�� ��� �
I ceNty fhat I am ihe . LICENSED CON7AACTOR �❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe elecfncel work at:
Job Atltlress (Street, Box, or Route Ne.1 C1w o:., r,.ne
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B0/1HD OF ELEp111CITY COPY
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