P - 79976REQUEST FOR ELECTRICAL INSPECTION
1 ��� � O� Minnesota Board of Eleciricity
� � 1821 Univers�ly Avenue Suite S-12B, Saint Paul, Minnesota 55104
. K�-� (651) 642-0800 1TY/MR5 1-800-627�529
.. wmv.electriciry.state.mn.us
I �NEW ❑REMOOEL ❑
over
I�udes fhe Servke aM/or Powar Suppty up to 500
Circuits and Two Insoecibn Tnps Each Dwellin
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(minimum total fee
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FOR OFFICE USE ONLV
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I certify Nat I am !he � LICENSED CINJTRACTOR ❑ COMPANY ❑ OWNER and hereby request iispedion of ihe electrical work at:
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