P - 78384REQUEST FOR ELECTRICAL INSPECTION
1� 4 9 2- 9 3 0� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800�27-3529 www.electriciry.state.mn.us
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I certify that I am ihe �LICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request inspection of the electric�.al work at: