P - 79406REQUEST FOR ELECTRICAL INSPECTION
1� 3 2 6� J O p � Minnesota Board of Electricity
w p 7827 Univereiry Avenue Suite 5428, Saint P ul, Minnesota 55104
+� :a+� (651) 642-OS00 TTYlMRS 1-800-627-3529 � �n�,��
www. electricity. xtate. mtt. us
identity Ihe work caveretl hy this requesl:
❑NEW �AEMODEL ❑ADDITION ❑REPAIR /1fL, /7CsUSi]Y'� C .J�—
Inclutles the Service andor Power Supply up to WO Amperes, All
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I cetlify that I am ihe� LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion ot ihe elecirical xrork at:
Job Atltlreas (SVceC Bax. or Roufe Nn 1 n... __
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