P - 79186REQUEST FOR ELECTRICAL INSPECTION
���� p� C O� � Minnesota Board of Electricity -
C� U 0 1821 University Ayenue Suite S-728, Saint Paul, Minnesota 55104
� (65t) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
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��ay�� �a�e. Rough-in Inspedion Required? ❑ Yes !�b Inspection Other Than Rough-In: Ready Now � Will Call
S' 13-(}� You must cail the inspector when readyl Date Ready
I certify that I am tlie ,p LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby iequest inspection of the electriql work at:
x
Job SRe Address (Str¢e4 Box or Route Nn 1 r
MARIEL
N/A
KOVAR ELECTRIC LLC I CA03644
dmg Address (Contractor. Company or Owner Perfaming InstaNatwn)
23049 ARROWHEAD ST' NVy SZ' pRANCIS MN 55070
horized Sign (Contradpr, Company or ortning Installation)
ucense Number
I �� -- -' /l � 763-753-5731
INSTRUCilONB ON BACK ep rF� . �ppy BOARD pF ELECTRICITY CAPy
� E&OOOOtM4 8A.2002