P - 78475REQUEST FOR ELECTRICAL INSPECTION
1� 4�r � U-16 2� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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I certify tliat I am tl�e ❑ LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the elecUical work at:
Job Site Address (SVeef. Box. or tioute No.) City Zip Code
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