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P - 77191REQUEST FOR ELECTRICAL INSPECTION 1��-$ 61 � Minnesota Board of ElecUiaty , 1821 University Avenue Suite 5-128, SaiM Paul, Minnesota 55104 ` (651) 642-0800 TfY/MRS 1-800�27-3529 www.e[ectricity.state.mn.us � t /i IIIIIIIIIIIII��iIII I��I) � - n � � � I Illllllilllllli��l�l C�G�. � � �� 1 7 1 6 8 6 L� � �� e� Roughi� Inspxl'wn Required? LJ Yes Jo Inspecfion Olher Than Rough-In: ❑Ready Now O Wql Call �� g You must c�l the inspector when ready! pete Ready. . I certi(y Uiat I am tl�e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at: Job Site Address (Street BoX or Route No.) CitY // T�p Cade �'`�/S� 14�.��Crrr.gir/ %� 2 �i� 4�<'�-ti %CT7ri o� � /� • I� r�ovae iwo (z) rnone � moen� � (�� 9 Contraaor Licanse Numbx Maater Etectridan a � �J� /► � ,� l�� License Plurnber (.�T(J ? u�s�rtucnoMS ori sncK aF rEUOw coPr // �ro oF �c�wcm corr L �� ll� - 6�' �� E&OOOOtA•14 8.1.2002