P - 80563�' REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of ElectriciTy
1-380-344 � 1821 University Avenue Suite 5-128, Saint Peul, Minnesota 55104
(651) 642-0800 TTYfMRS 1-800-627-3529
www. elecfriciry. s ta te. mn. us
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Date Reac
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I certity that I am the C] LICENSED COMRACTOR ❑ COMPpNY ❑ OWNER and here6y request inspection of ihe elecirical work a[: