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P - 84727I IIII��I II III II III II III I) II) II II) O III I� II� � I��I g21�UnitversaOAve. dRm. SR128ASt.I PauP MN 5O51pq �� ,� 0 2 9 9 3 9 6 2* Pnone (s� 2) s�a2 � � ' '�'� Home Duplex Apt. Bldg. Other: � ` '/ New Addn ` �-t !2C'C/��"�- Commercial Indushial Farm -'� Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: D er Ran e Elec. Heat Tem . Service "X" above the work covered by this request. Enter remarks in this space and on the bock of the whita copy only. Colculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee: OHier Fee � Service Enirance Sae Fee #� Circuils/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'SUSEONLY TOTAL � $ign/Outline Ltg. Xfmr. � �• ��� Alarm/Remote Control Swimming Pool I hereb certi fhaf I ins ecied the eledric insfallafion described herein on the dafes sfa�ed Irrigation Boo�-- Rough-In ' �.e��� t� $peciallns " - -� Final �_ _�c-� �- Investigative ee � THIS INSTALLATION MAY BE ORDERED DISCONNEC D IF NOT COMPLETED WITHIN 18 MONTHS. 2 9 9— 3 9 6 ��CE USE ONLY This request void 18 months from validafion date printed in this box. � �� �� :�_��� � 3(- � PLEASE PRINT OR TYPE Request Date Rough-in inspeciion required2 Yes � No Inspettion Other Than Rough-In: Q Ready Now Will Coll ����. �� (You must call fhe inspecior whe reody) Date Ready: � I, ❑ licensed controctor �owner hereby request inspection of the above electrical work at: Job Address SNeef, Bo or�oute No.) Ciiy Zip Code vF� I 1�� c� Cr- � �r. Fr'i � � sS y3 � Section No. Township Name or No. Range No. Fire No. County /_ 3 o a y /�/lo K a. Occ� ant Phone No. ��►oma � %�7�►om so�, S7 / �- � 12� I,) Power Supplier Address �' � � ^ � / � /� � NS�' m Ls - N. d> ! �v �'v,'S�' . Elechicol Conhador (Compony Name) Contrador License No. Master Lic. No. (Plant Eled. Only) �W /�lF/Z ,=.:, Mailing Addrcss (Contracfor or Owner P^rf`rming Insf�llafion) � .- S �rrl C Authorized Signo or erf ing Instollafion) ; Phone No. l, ` �r'a'��i�`w � : EB-00001 A-10 6/95 STATE 80 D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY