P - 80568REQUEST FOR ELECTRICALINSPECTION
Minnesota Board of Elecfricity
j-�$Q-3[}9 �; .. 1821 University Avenue Suite S42$ Saint Paul, Minnesota 55104
(651) 642-0800 TTY(MRS 1-800-6273529
www.electricity.state.mn. us
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I cerlify Mat I am ihe C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ot the electrical work at: