P - 80596a
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Eleciricity
�-(j$Q-',j'Z,$ ;"� � 1821 University Avenue Suite Sd28, Saim Paul, Minnesota 55104 _
(fi51J fi42-0800 TTY(MRS 1-800-627$529
www. electriciry. state. mn. us
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FOfl OFFICE USE ONLY
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I ceNfy that I am the L� UCENSE� GONTRACiOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the elecirical woYrc at: