P - 80226� REQUEST FOR ELECTRICAL INSPECTION �•
,� � � � � � � � � � Minnesota State Board of Electricity
1821 Universit Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '� '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs From validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required$ ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
' -�/ You must call the inspecfor when ready Dafe Ready:
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or te No.) City � Zip _Code I /
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Section No. Township Name or Na � Range No. Fire No. County �/'
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Occupanf /% Phone No.
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Ilecfrical Contracfor / Company Name Contracfor License No.
DEPE�IDABLE ELEC7RIG, INC.
i d Q�tr ���r�w#�rforming Insfallafion)
Coon Rapids, MN 55 � 2�' tj (� �¢
\uthorized Siqnature IContracto pany or Owner Perfqrrrhn9 ns a �
CnDV SEE INRTRl1CT10N_ YELLOW COPV