21-103709-Eligible Facilities Checklist-09-03-2021-V1Bulletin 081 – September 24, 2018 Page 1 of 3 k:\Handouts\Eligible Facilities Request
ELIGIBLE FACILITIES SUBMITTAL REQUIREMENTS
Eligible Facilities Request
DEPARTMENT OF COMMUNITY DEVELOPMENT
33325 8th Avenue South
Federal Way, WA 98003-6325
253-835-2607; Fax 253-835-2609
www.cityoffederalway.com
Site Address: ___
Parcel #:
Project Name:
Use this checklist to help gather all of the required information and documents in order to submit an eligible
facilities request pursuant to Federal Way Revised Code (FWRC) 4.24.020. Please note, incomplete applications
will not be accepted.
Submitted
Completed Eligible Facilities Checklist (following)
Check, cash, Visa/MasterCard for applicable fees
Site Plan – Three Copies
1.Minimum plan size of 11” X 17”.
2.North arrow.
3.Drawn to scale, dimensioned, and labeled.
4.Building footprint(s), including square footage.
5.Location and dimensions of existing structures, property lines, sidewalks, easements, street
edges, mechanical equipment, fencing, rockeries, and retaining walls.
Elevation – Three Copies
1.Minimum plan size of 11″ x 17″.
2.Drawn to scale, dimensioned, and labeled.
3.Front, rear, and side (labeled as north, south, east, and west) building elevation of existing
and proposed structures.
4.Height of structure calculations.
5.Roof-top and ground based mechanical equipment screen details.
Applicant
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
FILE NUMBER ____ ____ - ____ ____ ____ ____ ____ ____ - AD Date
PDF copies submitted online.
ATC 410158 - Verizon Upgrade - 13683206
205-235-6784Katie Kyle - Authorized Agent
2918 Clairmont Avenue South
Birmingham AL 35205
kkyle@craftongroup.com
1712 S 356th St, Federal Way, WA 98003-8312
282104-9125
ATC 410158 - Verizon Upgrade - 13683206
Please call/email for payment.
2 1 1 0 3 7 0 9 09/03/2021
Bulletin 081 – September 24, 2018 Page 2 of 3 k:\Handouts\Eligible Facilities Request
ELIGIBLE FACILITIES CHECKLIST
Proposed modifications to an existing tower or base station must meet at least one of the three threshold criteria
below for an eligible facilities request. For definitions please refer to FWRC 19.256.020. Check all that apply.
____ Collocation of new transmission equipment
____ Removal of transmission equipment
____ Replacement of transmission equipment
Is the proposed modification a substantial change as defined in FWRC 19.256.020? To determine, fill in the
appropriate information below. If the application does not meet all of the criteria below, then the project does
not qualify as an eligible facility and it is unnecessary to complete this form. To determine the correct review
process, refer to FWRC Chapter 19.256, “Wireless Communication Facilities.”
Criteria 1
• For towers other than towers in the public rights-of-way, it does not increase the height of the tower by more
than 10 percent, or by the height of one additional antenna array, with separation from the nearest existing
antenna not to exceed 20 feet, whichever is greater.
• For other eligible support structures, it does not increase the height of the structure by more than 10 percent,
or more than 10 feet, whichever is greater.
Criteria 2
• For towers other than towers in the public rights-of-way, it does not involve adding an appurtenance to the
body of the tower that would protrude from the edge of the tower more than 20 feet, or more than the width
of the tower structure at the level of the appurtenance, whichever is greater.
• For other eligible support structures, it does not involve adding an appurtenance to the body of the structure
that would protrude from the edge of the structure by more than six feet.
Criteria 3
• For any eligible support structure, it does not involve installation of more than the standard number of new
equipment cabinets for the technology involved, but not to exceed four cabinets; or,
• For towers in the public rights-of-way and base stations, it does not involve installation of any new equipment
cabinets on the ground if there are no pre-existing ground cabinets associated with the structure; or
• It does not involve installation of ground cabinets that are more than 10 percent larger in height or overall
volume, than any other ground cabinets associated with the structure.
Existing height of the structure: __________ (ft/ in) Proposed height of the structure: __________ (ft/ in)
Distance of proposed array from nearest array: ___________ (ft/ in)
What is the existing width of the structure at the level of the appurtenance? __________________ (ft/ in)
What is the proposed distance the appurtenance will protrude from the structure? ______________ (ft/ in)
How many new equipment cabinets are proposed? _______________________________________
There will be no changes to tower height.
120 ft No Change
No Change
There will be no changes to appurtenance.
No Change
None
Bulletin 081 – September 24, 2018 Page 3 of 3 k:\Handouts\Eligible Facilities Request
Criteria 4
• For all existing facilities, it does not entail any excavation or deployment outside the current site.
Criteria 5
• For all existing facilities, the modification does not defeat the concealment elements of the eligible support
structure.
Criteria 6
• The modification complies with conditions associated with the siting approval of the construction, or
modification of the eligible support structure or base station equipment; provided, however, that this
limitation does not apply to any modification that is noncompliant only in a manner that would not exceed
the thresholds identified above.
Will any excavation or equipment installation occur outside of the current site of the structure?
Yes No
Please describe any existing and proposed concealment elements: ____________________________________
__________________________________________________________________________________________
Will the proposal increase the visibility of the facility? Yes No
Identify known conditions associated with previous approvals of the existing facility.
__________________________________________________________________________________________
__________________________________________________________________________________________
Will the proposal violate any of the above conditions? Yes No
If yes, explain: _____________________________________________________________________________
_________________________________________________________________________________________
To Be Completed By Staff
Is this an Eligible Facility Request? Yes No
Does the proposal constitute a substantial change? Yes No
In accordance with FWRC 4.24.020, this application is hereby:
Approved Denied
___________________________________________ ___________________________
Director, Community Development Department Date
There will be no changes to existing concealment elements.
N/A