P - 77242REQUEST FOR ELECTRICAL INSPECTION
1— 610 - 6 9 7� Minnesota Board of Electriaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642A800 TTYiWIRS 1-800�27-3529 www.electricity.state.mn.us
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�9�� � RougfHn Inspecfion Required? U Yes 6L7�No Inspection Otlier Than Raugh-In: ('�eady Now O NAN Cail
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I certiry t I am the ICENSED CONTRACTOR ❑C�ANY ❑ OVIMER and hereby request inspecGon of Ihe electric�al work at:
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