P - 75733REQl1EST FOR ELECTRICAL INSPEC ON �
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c 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 551
(651) 642-080011Y/MRS 1-800-627-3529 www.electricity.state.mn.us
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Rough-dn InspecUon Requtred? � Y� ❑ No Ir�spedlon Other TFmn Rough-In: 0 Ready Now� Wi0 Cap
You must cep the Inapecbor when readyl Date Ready: �
I c;ertify tl�at 1 am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�tion of the dectrical work at
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Contradoe License Numl�r Meater Electridan or
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