P - 80017� REQUEST FOR ELECTRICAL INSPECTION
_ � � Minnesota Board of Electriciry
1-381-884 � 1821 University Avenue Suite 5428, Saint Paul, Minnesota 55104
(651) 642-0800 TTY(MFS 1-800-627-3029
www.electricity.state.mn, us
FOP OFFICE I15E ONLY
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I cedify that { am ihe Q LICENSED CONTRACTOR ❑ WMPANY ❑ OWNER and hereby request inspection o� ihe elecirical work at: