P - 79663. REQUEST FOR ELECTRICAL INSPECTION
.1 2 2 4 2 4 4 Minnesota Board ot Electricity
� � � 1821 Universily Avenue Su�e 5-128, Saint Paul, Minnesota 55104
� �; (651) 642-0800 TTY/MRS 1-800-6273529 ��� I
www.electrictry.state.mn.us .
❑REMODEL ❑
CIRCUITS OF LESS
REPAIR
Inclutles ihe Service andlor Power Supply up to 500 Amperes, AIl �
Circuits and Two Insoecfion Trios Each Dwelling Unit � 58�
(minimum total fee is
onusEaa. e �R7LPS�
PE�,
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descnbetl
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FOH OFFlCE VSE ONLY
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Req st Da[e: RougM1-in Inspection RequiredY Yes ❑ No InspecGOn OMe/ Then Rough-In: ❑ Reatly Nmv ill Call
1 � You must call tl�e inspector when reatly! �ate Ready:
I ce�lity ihal I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal wolk at
Jo0 Adtlress (SYreeG Box, or floNe NOJ Ctty Zip Cotle
7413 UMTVERSI7Y RVENLIE M FRIDLEY� MN
Phone
ElectriCel ConlraMOr / Company Neme Gontractor �censa Number
MIK-LYN EtECTftIC CO. CA8124S
AAailing Atldress (Con[2ctoL Canpany or Owner Pedortning Installatio�)
12358 Husiness Park Blvd, CHAMPLIN, J
L-�
EBCC001A-13
�r�-c�
BORPO OF ELECTFICRY COPY
55316
421-77
INSlPIICTIONS ON
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