P - 79467REQUEST FOR ELECTPoCAL INSPECTION ��,�
.1 13 9 � r{ ,5 Minnesota Board of Electricity
� � 1821 UnrversiTy Avenue Suite 5-128, Saint Paul, Minnesot2 55104 �.
��� I �. (651) 642 0800 TTY/MRS 1-800-627-3529
wmv.electricity.state.mn.us
: worx cmerco oy mis reques[: L�l ���� � � ��
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❑REMOOEL ❑ADDITION ❑REPAIR
Includw the Service anNar Power Supply up to 500 Amperes, All
total fee is
6
- THIS INSTALLATION MAY BE ORUERED DISCONNECTEO IF NOT COMPLE7ED WIInIN ltl Munins
FOfi OFFICE USE ONLY
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I��� J ��� I �ou must call tM1e inspedar when rea0y! I Date Reetly: � I
I cahity that I am the�'OCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eledrical work at:
Phone
orOwner PeROrming Insfzllatlon)