P - 80590REQUEST FOR ELECTRICAL INSPECTION
+ Minnesota Board ot Elecinciry � "" �
1-380-322 � 1821 Universiry Avenue Suite S-128, Salnt Paul. Mlnnesot2 55104
(657) 642-0800 TTY/MRS 1-800-627-3529
www.electriciry.state.mn. us
IOeMity Ihe work covered by this request
'7MIEW ❑REMOOEL '7AODRION
�ONE 8 TWO
Ir�cludes the'.
CONfROL, SIGNALING Qrcuns antl
� � �II� IIII, II,I�II II�I ��/ �
EAGH UNIT
total fee is
29Q65
FOR OFFICE USE ONLY
2 9 0'� 5 �d-So
RequeSf:Da�e; flougRinlnSpectiOnRequired? ❑�es ❑aC ��speclion0�herT�anHOUgo-in: uneaoy��ow �..��,.,e�• I
� �8l17(01 v ��� �^��O M1e �N o� R tly.
I certity that I am the � LICENSE� CONTRACTOF � COMPANV ❑ OWNER and hereby request inspection ot the electrical work at:
Job Atltlress (SVeat, 8ox, o� Roote No.) Clty Zip Cotle
o� Owner
ANCkfA
License
OF ELECTRICITV C�PY INSTRUCTIONS ON BA�K�F YELLOW COP`