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P - 78929c(� REQUEST FOR ELECTRICAL INSPECTION 1� 6 � 1� U J� � Minnesota Board of Electricity - 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us III�I III�I I��II IIIII IIIII I�II� II�II �� I� ��,� ,k_ u�,x i,_{ �� I� � g� 16016933 / �0��- d l/S2/ � s c� RO`+1O" "a'B� Roughan Inspection Required? �/es ❑ Ne Inspeclion Olher Th� Rough-In: ❑Ready Now I Call ��—+ �—� You must call the inspeda when ready! pete Ready: I c�rtify tliat I am tt�e ❑ LICENSED CONTRACTOR 0 CON�ANY ❑ OWNER and f�ereby request inspection of tl�e electrical work at: --.. . __. . ,k„ e.,. �