Äîäàòîê ¹ 2

 

 

 

 

ÏÅÐÅ˲Ê

çàõèñíèõ ñïîðóä, çäàíèõ â îðåíäó_______________________ì³ñòà ( ðàéîíó)

ñòàíîì íà «___»___________________ 20___ ðîêó.

 

 

 

 

 

 

 

 

 

 

¹ ï/ï

 

 

 

 

 

 

 

 

 

Êàòåãîð³ÿ ÇÑ

(ñõîâèùå, ÏÐÓ)

 

 

 

 

 

 

 

 

 

²íâåíòàð

íèé ¹ ÇÑ

 

 

 

 

 

 

 

 

 

̳ñòê³ñòü/ïëîùà

(÷îë/êâ.ì.)

Àäðåñà (í.ï., ðàéîí, âóë., ¹ áóä. àáî òåðèòîð³ÿ ÎÃÄ)

Ðåâê³çèòè áàëàíñîóòðèìóâà÷à (ÎÃÄ, ÆÅÊ, ÂÐÅÆÎ, äð.)

íàçâà îðãàí³ç.;

Ï.².Ïá. íà÷-êà, ¹ òåë.;

Ï.².Ïá. ÍØ, ¹ òåë.

Ôîðìà âëàñíîñò³:

äåðæàâíà;

êîðïîðàòèâíà;

ìóí³öèïàëüíà; ³íøà

²íôîðìàö³ÿ ïî îðåíä³

Ïëàíóºòüñÿ ï³ä ñïèñàííÿ:

äà;

í³

Òåõí³÷íèé ñòàí ÇÑ ÖÎ (â³äïîâ³äíî äî ÄÁÍ 2.2.5-97):

â³äïîâ³äàº;

íå â³äïîâ³äàº

 

 

 

 

 

 

 

 

 

Ïðèì³òêà

Ï.².Ïá. îðåíäàðÿ;

¹ òåë.;

ï³ä ùî âèêîðèñòîâóºòüñÿ îᔺêò

 

 

 

 

 

 

 

 

 

¹ äîãîâîðó

Òåðì³í

Îðãàí³çàö³ÿ, ÿêà îôîðìèëà äîãîâ³ð îðåíäè:

ÐÂÔÄÌ; Çàïîð³çüêå óïðàâë³ííÿ ÆÊÃ;

ì³ñüê³ òà ðàéîíí³ â³ää³ëè ç ïèòàíü îðåíäè òà ïðèâàòèç. (âêàçàòè äàòó ³ ¹);

ÂÐÅÆÎ;

ÎÃÄ

 

Íàÿâí³ñòü äîçâîëó îðãàí³â ÖÎ;

ãîë.óïð-ÿ ç ÍÑ;

óïð. ÍÑ ì³ñò;

â³ää³ëè Í  ðàéîí³â

ïî÷àòîê

çàê³í÷åííÿ

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_________________________________                                                          ________________________                                                                                                                                                  __________________

(ïîñàäà)                                                                                                                                       (ï³äïèñ)                                                                                                                                                  (ϲÁ)

"___ "_____________________ 20_____ ð.