P - 78246�qc REQUEST FOR ELECTRICAL INSPECTION
1��F V o- 8 7 3� Minnesota Board of Electrialy -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
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►teq uate:�r Rough-in Inspection Required? ❑ Yes �No Inspection OtherThan RougMn: �Ready Now Will Call
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I certify that I am the �',LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest mspection of the electrical work at:
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