P - 78870, REQUEST FOR ELECTRICAL INSPECTION
�����- 7 4 5 Minnesota Board of Efectricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529 -
www. electricity. state. mn. us
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FOR OPFICE USE ONLY
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Request Date: I Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now
� �'�( � (,) � � You must call the inspector when readyl I Date Ready:
I certiiy that I am thec�'GCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeciion of the electrical work at:
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