P - 79660`� REQUEST FOR ELECTRICAL INSPECTION
1 2 2 4 2 4 7 Minnesota Board of Electricify
� � � 1821 Universiry Avenue Suiie 5428, Saint Paul, Minnesola 55104 �
{ssi� saz-oeoo TTY/MR5 1-800-627-3529
7
www.electrecery.state.mn.us ��-� '+�'•
❑A�OITION ❑REPAIR
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over
Inclutles the Service anNw Power Supply up ro 50� Ampe2s, All
Circuits and Two Ir�soection Trios Each Dwellino 11nA W$80
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total fee is
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I �(� � V � � vou must call t�e inspaclor wnen reatly! I DaCe Reatly: �
I ceiNfy that I am ihe ICENSE� CONTRACTOR ❑ GOMPANY ❑ OWNER antl hereby reqoest inspection of ihe electncal work at
Job Atltlress (SVeet, Box, or Route No.) Ciry Zip Catle
7419 UNIVERSITY AVEHUE M FRIDLEY� MN
� I Phone
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Electrical Contracta' / Company Name ConVaclor License Num6er
MIK-LYN ELECTRIC C0. CA01246
Mailing Atltlress (COnVactoq Compeny or Owner Pedortning Ins�211ation)
12356 Husiness P�rk Blvd, CHRMPLI
MN 55316
BOpF00FELECTNICrtYCOW �. — INSTFUCTONSON