P - 81339REQUEST FOR ELECTRICAL INSPECTION �
1 3 4 7 3 61 Minnesota Boarii of Ele�ricity
� � 1821 University Avenue Suita S42$ StiM Paul, Minnesota 55104
..- �"""��.: (651) 642-0800 TTY/MqS 1-800-627-3529
www.electriciry.state.mn.us
Iden�ity Me xrork covered by this request p p
❑NEW $�REMOOEL LyIADDITION ❑REPAIR �_. (l C.�'e2 L-e-U-ti-�
Ir�cludes the Service arid�or Power Supply up to 500
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FOR OFFICE USE ONLV
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iinimum total fee is $20) ( `✓"'
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allation d[ac�i0etl heRin m Ihe tlates sla�ed:
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I � �� O`� ( j'�-J I You must call pie inspector when ready! I Date Reatly: I
I ceeiy that I am ihe � LICENSE� CONTRACTOR Q COMPANY �OWNER and hereby request irispeclion ot ihe elecVicai work at:
,bb Atltlress (Slreet, Box, or Route Na) City Zip Co�
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Seciion Township Range Fir¢ No. County
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