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Community Development Department • Planning Division Project Name/Address*: Project Case No.*: Submittal Date*: Fee*: *To be completed by City staff Administrative review is generally permitted for the following types of facilities, provided that the facilities meet requirements of BMC Chapter 17-35-020. ● Cable microcell networks ● Antennas on existing buildings ● Antennas on existing towers. The estimated review time for a facility that qualifies for administrative review is approximately two weeks. Review times may vary depending on case load, the need for additional information, or other factors. The estimated review time does not apply to facilities that will require a revocable permit, a Use by Special Review application, or administrative review applications that are referred by the City Manager to the Planning and Zoning Commission and City Council for special review. Summary of Request: Property Location: Address: Parcel Number: General Location: Applicant Information: Applicant: Person to Contact: Address: Phone: E-Mail: Owner Information: (per current title policy) Applicant: Person to Contact: Address: Phone: E-Mail: As owner of the aforementioned property, I hereby consent to the submission of this Application for Development Review and authorize the applicant to act on my behalf with regard to this application. Owner: Signature: Please Print One DesCombes Drive • Broomfield, Colorado • 80020 • [PHONE REDACTED] • www.broomfield.org SIGN ---PAGE BREAK--- Development Review Application Packet Wireless Facilities (Administrative) Page 2 of 2 Applicants must submit the following information in order for the application to be deemed complete and accepted. All information must be submitted following the specifications listed in the Submittal Guidelines document. $200 Application Review Fee Broomfield accepts payment of fees by credit card* (after submitting your application please call: [PHONE REDACTED]) or check (made payable to: The City and County of Broomfield). Please include a reference to the project name or property address in the subject line of the check if sending prior to the issuance of a case number by Broomfield. *Note that there is a processing fee of 2.65% for payments made by credit cards. APPLICATION SUBMITTAL DOCUMENTS: Submit email with a pdf of all items listed on the checklist below to [EMAIL REDACTED]. Dropbox or other file sharing tools may be used if needed. All files must be named and organized in accordance with the Submittal Guidelines. Application Packet (mm-dd-yyyy) Project Description (mm-dd-yyyy) (separate write-up in letter format) Site Plan (mm-dd-yyyy) Proof of Ownership (mm-dd-yyyy) (Title Commitment current within 60 days from date of application) Include electronic link with live links to exceptions Vicinity Map (mm-dd-yyyy) Engineering Report (mm-dd-yyyy) Visual Analysis (mm-dd-yyyy) (mm-dd-yyyy) - other requirement(s) as requested To be completed by Planning: INCOMPLETE APPLICATION AND APPLICANT INFORMED ON: (date) APPLICATION COMPLETE AND ACCEPTED ON: (date) City and County of Broomfield • Community Development Department • Planning Division One DesCombes Drive • Broomfield, Colorado • 80020 • [PHONE REDACTED] • www.broomfield.org