P - 80601. .I � REQUEST FOR�ELECTRIGAL WSPECTION
- Minnesota Board of Electriciry
1-380-332 � �821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651�642-0800 TTYlMRS 1-800-627-3529
www. elecfricity. state. mn. us
IIII,I II„I III, I�III �1" III,I II�� 11 I�I
Vou mustcall
iOR OFFICE IISE ONLY
2�^;
�{Py i ao.so
itl? ❑ Yes ❑ Inspecnon Othe� Than Rough-in: eatly Now
when reativ! Date Reativ:
I ceRily thak I am the L� LICENSE� CANTRACTOR ❑ COMPANY ❑ OWNER and hereby request Inspeciion oi the electrical work at: