P - 78638REQUEST FOR ELECTRICAL INSPECTION
1 3� 7 g 6 8 Minnesota Board of Electriciry
� � �m � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
• www.electricity.state. mn. us
I 1 certify that I am thB�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
�o ww �n is i/ I/CUW BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY