P - 79465REQUEST FOR ELECTftiCAL INSPECTION :��
1� 13 9� 1't �- Minnesota Board of Electricdy
1821 University Avenue Soite S-128, SaiM Paul, Minnesota 55104 �.,
y,, �ssi> saz-aaoo rrvMtas i-aoo-sz�-ss2s
�.��1 www.electriciry.state.mn.us
❑ FEPAIfl �✓l � ��u` �� ' ` �
Inclutles U�e Service anNOr Power Supply up to 500 Amperes. All
f.lmuitc anA Twn Irtnarlinn Trins Each Owellino 11nA �$8(
THAN 50 VOLTS
FOIi OFFICE USE ONLV
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I`L�� �O ( I You must call pie inspec[or whan reatly! I Dete
I cetlity that I am the �'[ICENSED CANTRACTOR ❑ COMPANY ❑ OWNER
� Powar
or Owner Pedortninq
Phone
License
total tee is
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2�-6��� �5.so
and hereby request inspection of the eledrical work at
Zip Code