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125588483 <br />GAS ELECTRIC <br />Gas Distribution Facilities <br />and Non-Residential Service Services: <br />Electric Distribution Facilities <br />and Non-Residential Service Services: <br />#gasDistFacilities#Applicant: $#elecDistFacilities#Applicant: $ <br /> $0.00 PG&E: $81,138.38 PG&E: <br />GAS DISTRIBUTION TRENCH <br />#gasDistTrench#Applicant: $ <br /> $0.00 PG&E: <br /> · Applicant's statement of costs include: overhead or underground service conductors,poles, service <br />transformers, connection fittings, service pipe, valves, service connections,and other PG&E-owned <br />service equipment, as detailed in Gas and Electric Rule 16. <br /> <br /> · Applicant's statement of costs DOES NOT include: inspection fees, nonresidential service costs, <br />regulators, or PG&E-owned metering equipment. <br />I declare under penalty of perjury that the foregoing is true and correct. <br />APPLICANT'S ELECTION NOT TO PROVIDE COSTS: (if this option selected, box must be checked) <br />I choose not to provide to the utility my refundable costs for this project as taken from my <br />contract with my contractor, or as performed by myself, and acknowledge that PG&E will use <br />its estimate of the refundable costs for this project in the contract between it and me. <br />#signDateSACAC#Executed on at <br />(Date)(City) <br />By: <br />CITY OF REDWOOD CITY, A GOVERNMENT AGENCYPrint Applicant Name: <br />#sigSACAC#Signed: <br />Assistant EngineerTitle: <br />#titleSACAC# <br /> <br />Form 79-1003 <br />Advice 4350-G/6050-E <br />February 2021 <br />†Information collected on this form is used in accordance with PG&E's <br />privacy policy. The privacy policy is available at pge.com/privacy <br />Automated document, Preliminary Statement, Part A <br />Page 2 of 2 <br />#applicantSACAC# <br />Vicky Lau <br />6.A. - Page 9 of 13 <br />13