P - 79411REQUEST FOR ELECTRICAL INSPECTION
1� 3 4 6- 4 51 Minnesota �ard of ElecVicity
1827 Unrversi Avenue Suite 5-128, Saint Paul, Minnesota 55104
�a � (651) 642-0800 TTYM1fiS 1-800-627-3529
www.eIeccriciry.state. mn. us
❑REMODEL ❑ADDRION ❑FEPAIR
THAN
fncln0es the Service a�rn Power SuFpy up to 500 Amperes, NI
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total Fee is
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I certity thaf I am ih�C(CENSEO CANTPACTOR ❑ COA7PANY ❑ OWNER and hereby request inspecfion of the elecMCal work at:
Job Atltlress (Sheel, Baz. or e NoJ Cryy Zp �¢
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OEPENDABLE ��L�C�tI� INC.
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