1017271_Application_Sep__9_2021_11_15AMCITY OF EDMONDS M BuildingPermit.com
Plumbing Application #1017271 -Distinctive Dentistry
Applicant
First Name Last Name Company Name
Bob Satko Local Plumbing And Conctruction Inc.
Number Street Apartment or Suite Number E-mail Address
1496 satko@outlook.com
City State Zip Phone Number Extension
Maple Valley WA 98038 4254326647
Contractor
Company Name
LOCAL PLUMBING & CONST INC
Number Street Apartment or Suite Number
PO Box 1496
City State Zip Phone Number Extension
Maple Valley WA 98038 (425) 432-6647
State License Number License Expiration Date UBI # E-mail Address
LOCALPC063J9 8/23/2023 FD1491379 satko@outlook.com
Project Location
Number Street Floor Number Suite or Room Number
22815 EDMONDS WAY 1 na
City Zip Code County Parcel Number
EDMONDS 98020 27033600102700
Associated Building Permit Number Tenant Name
Distinctive Dentistry
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
* DERKSEN LLC*
Number Street Apartment or Suite Number
19827 15TH AVE NW
City State Zip
SHORELINE WA 98177
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 9/9/2021 Submitted By: Bob Satko
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CITY OF EDMONDS MyBuildingPermit.com
Plumbing Application #1017271 -Distinctive Dentistry
Project Contact
Company Name: Local Plumbing And Conctruction Inc.
Name: Bob Satko Email: satko@outlook.com
Address: 1496 Phone #: 4254326647
Maple Valley WA 98038
Project Type Activity Type Scope of Work
Nonresidential Alteration Plumbing
Project Name: Distinctive Dentistry
Description of Work: 3/4" dbl ck backflow assembly
Project Details
Type of Use
Work includes commercial kitchen, food svc, med
gas, lab, medical use, or dental use.
Associated Building Permit?
There is or will be a building permit associated with
this work at the project location.
Additional Project Information
Total number of fixtures being added or altered 1
Work Location
Work Description/Location (example: 1 st floor, 1 st floor
Master Bath, Garage)
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