P - 79421REQUEST FOR ELECTRICAL INSPECTION � e�
�//j(� Minnesota Board of ElectricRy ���
yr �[. V- 9 6 6 � �821 Universiry Avenue Swte S 12° Sain1 Pau, Minnesota 55104
(651) 642-080D T7YMiR5 1 800-6273529 � , �)� �
www.e(ectricify.s(ate.mn.us �l./`
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I �NEW i�REMODEL ❑ADDITION ❑REPAIR
50
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Includes Ihe Service anNor Pawer SuOPIy up �0 500 Amperes, All
Circui�s and Two Inspection Trips EacA Dwelling Unil W$8(
tolal fee is
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. _TFifS IPiSFALL#�'ION MAY-6t vnuencu uuvv�...�...�,._., .. _,��.�—..-..---___._ --. __ .
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FOP OFFICE USE ONLY
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Yw must call the inspectot when reatlyl Date Ready:
I cebty that I am the �LICENSED CONTRACTOR �❑ COMPANV ❑ OWNER and hereDy request inspaction of the electncal work ak -;
Job Ad�lress (SVceq Bon, or P ule No.) n Ciy z�P ��a .� �
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ELECT.� INC.
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