1262 Deerridge Ct - Electrical PermitsThis re4uest void
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;Request Pat { RQUhed?inSpei n ?peady NoWill NotifyInspec? Q ?? es ? No tor When Ready
ensed Electrical Contractor I hereby request inspection of ebove
a? -.,.L ;nntatled at:
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Street Address, Box or Ro te No. _
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ecUon o. Township Name or No. ange No. COyL?Y
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Power SuPPI r Address c
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Mailing Addre?s (Ci?ntra r or Owner aking In lail tion)
Authorize ignature o ntractor e ak' stallationl Phone Number
T ? ?racocrrinfu acAUFST Wlll NOT
MINNESOTA STATE BOD OF ELECTRICITY J? BE ACCEPTED BY THE STATE BOARD
Griggs•Midway Bldg. oom N-791 / f UNLESS PROPER INSPECTION FEE IS
7821 University Ave., t. Paul. MN 55104 U ENCLOSED.
Phone (812) 297-2111
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/ i REOUEST FOR ELECTRICAL INSPECTION
See instruclians for comoletiny this form on beck of yallow copY. E8
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