P - 79658REQUEST FOR ELECTRICAL INSPECTION �.�
1. 2 2 4 2 4 5 § Minnesota Board of Electriciry
� � � 1821 Universiry Avenue SuRe 5-128, Saint Paul, Minnesota 55104
(651) 642�0800 TTY/MRS 1-800-627-3529 ��!
wwrv.eiecMciry.state.nta.us ��-lf. �
work coveretl 6y this request:
❑REMODEL ❑ADOITION ❑HEPAIR
CIRCUITS OF LESS THAN 50
Includes the Sernce and/or Pmver Supply up to 500 Pmperes, All ✓
Ci�n�its aiM Twn Insneciion Trius Each GweNina UnN �$80
tofal f¢¢ i5
���"_ J 37�'e71 �d•
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FOR OFFICE USE ONLY
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V� U d� Vou musl callihainspectorwhen reatly! Date Reatly:
I cenm� Nat I am Ne LICENSEO C�NTRACTOR ❑ CoMPANY ❑ OWNER and heieby request inspedion of the eledrical work al:
Job Atltlress (SYreet, 6ox, or Route No. Ciry 7jp Cotle
74Z5 UIJIVERSI�Y AVENUE hi FRIALEYT MF!
Secllon Townshi0 ._ _ a . Fire No. Counm . �
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ElecVical Coniraqw / Com an Name Contrac�or License Number Mas[er LiCense
MIK-LYN EPL�CTRIC CO. CA01246
Mailing Adaress (COMrac(or, Company or Owner Pertorming InshalW[ionJ
12358 Business Fa•r1; Rlvd,, CNRMFLIM� MN JJ3SEY
AumP'122tl Siqf18W[yjCqflt�aq0�. COmp3flv O� OW�B/f�tiotrtiina IM�Ilatienl . PM1nnn �
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INSTPOCTON$ ON BRCN OF YELLpW COPY