P - 80574- REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-380-355 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 T7YIMRS 1-800-627-3529
www. elecfricity. state. mn. us
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I certity [hat I am the L°i LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGOn of the electrical work at: