P - 77264/� REQUEST FOR ELECTRICAL INSPECTION
1� 6 7 9����F � Minneso4a Board Crt Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
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R�� ua� Rough-in Inspection Required? LJ Yes � No Inspection Other Than � gh-In: eady Now�ll Call
'�� Vou must call the inspeclor when ready! Date Ready:
I certiiy that I am U�e LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Address ( Box, or Route No.) City �p �e
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E&00001M10 8.1.2002