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P - 79994
,.. . REQUEST FOR ELECTRICAL INSPFJ.CTION .�„g� � Minlle96ta Board ot Electnc�,., � ^ � � �� 15 5- 3 2 0 � �gZ� Univereity Avenue Surte 5-128, Saint Paul,'Minnesofa 55704 3 :p aa: (651) 642-0800 TTYlMRS 1 800-627-3529 www.electricity.state.mn.us �i�i�� ��iii ��i�� �lill i���� ��ii� ����� 1���� ii« �t�� You musccellihe FON OFFICE USE ONLY N? Yes No Inspi when reetlN Dete �`�� 85�� �. 1 cefiy lhat I am fhe j�1 LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeciion of the elecirral work at: