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443LafayetteRoadNorth
St. Paul,MN55155
www.dli.mn.govMINNESOTADEPARTMENT
ofLABORandINDUSTRY
JOBSITEDAILYATTENDENCERECORDConstructionCodesandLicensingDivision
ElectricalInspections
6512845026DATE
PRIMEELECTRICALCONTRACTORNAMEPRIMEELECTRICALCONTRACTORLICENSENUMBERCONTRACTOR\'SONSITEREPRESENTATIVEINCHARGEREPRESENTATIVE\'SPHONENUMBERJOBSITENAMEJOBSITEADDRESS(includingcityortownshipandcounty)PRINTEDNAME
SampleName1WHODOYOUWORK
FO
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