P - 79977REQUEST FOR ELECTRICAL INSPECTION
Q (] � Minnesota Board of ElecVicity
1� 19 3� O�.7 a" 1821 University Avenue Suite 5-128, Saint Paul, Minnesola 55104
. >*� (651) 642-OS00 TTY/MRS 1-500-6273529
� www.eFectricilv.state.mn.us"•_
� �NEW ❑REMODEL ❑ADDITION
Includes ihe Service aM/or Powar Supply up to 500 Amperes. All
CircuBs antl 7wo Insoectbn Tnos Each �wellinp UnA �$BC
FOR OFFICE USE ONLY
Illllfllllllllllllllllllll llllllllillllllllllllll �
3E 1 1 9 3 B 6 9 1 3�
Fequest Date: Rough-in Inspeclion Fequiretl? ❑ Ves ❑ No Inape
' O Vou musl call ihe inspector wM1en reatlyl Date
I ceNfy ihat i am the �ICENSED COMRACTOR ❑ GOMPANY ❑ OWNER
.bb Atltlress (Street, Bor.�or Route No.) � / ��f�� -
� Occupant
DEP£NDABLE
� d �
Ceon Rapids,
INC.
No.
1ee
��a��- ��.5�
and here6y request inspeclion ot ihe eleclrical work at:
3-
G!i!/if.i.Q 5 � !J ! —J FJ
EB-OOOOtA�13 ]R2p00 60RND OF ElECT111LRY LOVY INSTRUCTpNS ON BACK OF VELLOW COPY