P - 79099/� c REQUEST FOR ELECTRICAL INSPECTION
��, R' 6 g�-1. � V 1 0 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651)642-08001TY/MRS 1-800-627-3529 www.electricity.state.mn.us
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R�& Date: ►tqig►,in �napection Required2 ❑ Yes tris
pedion Other Than Rough-In�Ready Nav 0 Will Call
r_ a `� �(� l% You must caN Me i�peda when readY! Date Ready:
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I certify fiat I am the�lCENSED CONTRACTOR ❑COI�WANY ❑ OVYNER and hereby request inspection of the electrical work at:
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