P - 77613REQUEST FOR ELECTRICAL INSPECTION
1� 4 0 4- 613 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55t04
(651) 642-0800 TTY/MRS 1-800�27-3529 www.e[ectricity.state.mn.ur
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�� Rough-in Inspection Required? l� Yes ❑ No I�pection Other Than RougMn: ❑Ready Now �I Call
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i O You must wll the inspeda wtien ready! pete Ready.
I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OIAMER and hereby request inspection af Ihe electricxl work at:
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:7tOM8 ON BACK OF YELLOIM COPY BOARD OF ELECTRICRV COPV EB-00007M14 8.1. 2002