P - 79359REQUEST FOA ELE�TRICAL INSPECTION
1�3 6 8 4 6 t Minnesota Board of Eleotricity
� � 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104
! +a+-� (651) 642-0800 TTV/MRS 1-B00-627-3529
� www.electncitytsdate. mn.us
FOfl OFFICE USE ONLY
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� Request
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I certity lhat I am ihe�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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