P - 79947REQUEST FOR ELECTRVCAL INSPECTION
1� 16 0- 5 8 6�� Minnesota ryard of Electricity
s iffi7 Universi Avenue Suite 5-128, Saint Paul, Minnesola 55104
, x= (651) 642-0800 TTY/MFS 1-500-627-3529
www.etectricity.saate.mn.us
Idenfrfy tlie work coveretl 6y Ihis request /'� _� N � n �� /1 �n �/ir
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❑NEW ❑REMODEL ❑AODITION ❑REPAIR
THAN 5o VOLTS
ONE 8 TWO FAMILV �WELLINGS, tAGH UNI I
Includes the Service anNor Power Supply up to 500 Amperes, NI
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' f-0R OFFN:E USE ONLY
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I /�''/ p(oC�(J� I You must call ihe inspecro� when reatly! � I Date Ready: � I
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. I cerGy that I am ihe �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection M ihe electrical work at:
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