P - 80573� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Eleciricity
1-380-354 � 1821 University Avenue Sui�e 5-128, Saint Paul, Minnesota 55104
(651) 642�0800 TTYIMRS 1-B00-627-3529
www.electricitys[ate.mn.us '�' �
IIIIIIIIIIIIIIIIIIIIIIIII�� III4III
1 3 8 0 3 5 4 9
You must call Uie inspec�or when
FOP OFFICE USE ONLY
290��
��9�,
Yes L]17 Inspec�ion OtherThan Rough-in:
tiv! Date Readv:
da<so
I certify fhat i am [he L? LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspecAOn of [he electrical work a�: