P - 79428I REQUEST FOR ELECTRICAL INSPECTION ,��
1 s 3 8 2 3 g Minnesota Board of Electricity
� � �-� 1827 Universiry Avenue Suite 5-728, Sairn Paul, Minnesota 55104 �; �
(651) 642-0800 TTV/MRS 1-800-627='3¢29
` www.eleciriciry.state.mn. �
Itlentify the work covered �'this request
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❑NEW ❑REMODEL ❑A�DITION ❑REPAIR / ,f/� . ( �. � r ' �% /{'��
over
Includes the Service anNor Power Suppy up to 500 Amperes, All
Circuits and Two Insoection Tnos Each Dwellina UnB �$BO ���
FOii OFFICE USE ONLV
11111 IIIII Illl lllll ii 1111111
fee is
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I cetlliy ihat I am LICEN^D CONTPACTOR .❑ WMPANY ❑ OWNER and herehy reques� inspection 0� �he eledrical work at:
� b Address �Streeq Boz, or Ro e .) . �y Zip Cotle �;
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FB-00001A-13
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80ppD OF fLEGTPICRY COPY
License
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INSTHUCTIONS ON BACK OF YELLOW COGY