P - 80021- REQUEST FOR ELECTRIGAL INSPECTION
Minnesota Board of Electncity
1-381-924 � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �'
(651) 642-08001T/IMRS 1-80P6273529
www.efectricity. s[ate. mn. us
FOR OFFICE USE ONLY
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I I certity ihat I am the LICENSED CONiRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecirical work at
Job Atltlress (Stree�, Box, or Rou[e No.j Ciry Zip fqde
6900 E Rl�sr Rd FRIDLEY 55432
Section Township Range Fire No. Coun�y
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Compeny o� Owner Pertorming I�stallation)
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License Number
BOAR� OF ELECiRIQTV COPY INSTflUCTIONS ON 6ACK OF VELLOW