P - 78566REQUEST FOR ELECTRICAL INSPECTION
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1 ��� O�� tl° $ Minnesota Board of Electriciry
e � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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e � (651) 642-0800 TTY/MRS 1-800-6273529 �._.�
` www.electricity.state.mn.us
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.._._.. ._ �____�.__ e......:,ew� n v� Nn Insoection Other Than Rough-In: eady Now ❑ 1Afill Call
Reqy� D te:
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I certify that I am the
Job Address (Street,
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Power Supplier
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You must call the inspector when ready! � � Date Ready: �
NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlre electrical v�rork ffi:
ute NoJ City Zip Code
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Range Fire No. County
� � Q181 P - -`�S«
Address
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License Number , _� Master
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