Äîäàòîê ¹ 6

 

 

 

 

²ÄÎ̲ÑÒÜ

ïðî  çàáåçïå÷åííÿ  ___________________________ì³ñòà ( ðàéîíó) àâòîíîìíèìè äæåðåëàìè åíåðãîçàáåçïå÷åííÿ

ñòàíîì íà «___»_________________ 20____ ðîêó

 

¹

ç\ï

Íàéìåíóâàííÿ òà ìàðêà àâòîíîìíîãî äæåðåëà åíåðãîçàáåçïå÷åííÿ

( âðàõîâóþ÷è ÑÁÏÀ)

гê âèãîòîâëåííÿ

Íàÿâí³ ÀÄÅ

Ðîáî÷³é ñòàí

( ÿêùî Ͳ , âêàçàòè ïðè÷èíó)

Çàãàëüíà ïîòðåáà

Îð³ºíòîâíà ñóìà ïðèäáàííÿ òà ï³äêëþ÷åííÿ

Íàÿâí³ñòü ïðîåêòíî-êîøòîðèñíî¿ äîêóìåíòàö³¿

ʳëüê³ñòü

Ïîòóæí³ñòü

(êÂò)

ʳëüê³ñòü

Ïîòóæí³ñòü

(êÂò)

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____________________                               ________________________                                  _________________

                (ïîñàäà)                                                                                                   (ï³äïèñ)                                                                                   (ϲÁ)

«____»_____________________20_____ð.