Finance Department 1400 Highland Avenue Manhattan Beach, CA 90266-4795

Telephone (310) 802-5561 FAX (310) 802-5551 TDD (310) 546-3501

FILM PERMIT APPLICATION

 PRODUCTION MUST HAVE A VALID EMAIL ADDRESS AND CELL PHONE NUMBER.
 EMAIL BACK TO LBOICE@CITYMB.INFO -OR- FAX 310-802-5551
(PLEASE PRINT)

APPLICANT INFORMATION
Lead Contact Name & Title:       Contact Numbers:
      Office:      
      Cell:      
     
Address: Fax:      
           
      E-mail:      
           
Location Manager:       Cell:      
     
Assistant Location Manager:       Cell:      
     
Director:       Telephone:      
     
Producer:       Telephone:      
     

PROJECT
Project/Production Name & Number:      
     
Project/Production Type: Commercial Motion Picture Educational

Television Still Photography Student

Other/Notes:      
________________________________________________________

This application requests permission to work on       Date(s) /       Time(s).

LOCATIONS
Date/Hours:            
1.       From:       To:      
Date/Hours:            
2.       From:       To:      
Date/Hours:            
3.       From:       To:      

LOCATION DESCRIPTION
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Check One: City County Private Property School District

Check One: Residential Commercial School Other

ELEMENTS
Animals Chemicals Fire/Flames
Explosives Special Effects Generator
Street Closure Emergency Services Traffic Control
Lighting (explain)      
______________________________________________________________________________

Other:      
_______________________________________________________________________________________

If any of the above are checked, please give a detailed description:      __________________________________

PERSONNEL / VEHICLES
CAST:       CREW:      

Catering
Automobiles (qty)       (qty)       Trucks (qty)      
Trucks
Motorhomes (qty)       (qty)       Trailers (qty)      
Vans
Other Crafts (specify):      
__________________________________________________________________________

FILMING ACTIVITY DETAILS & SPECIAL REQUESTS (USE ADDITIONAL PAPER IF

NEEDED)
Explain:      

     
     
     

     

_______________________________ ____________
Signature of Applicant Date

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 For Office Use Only – Do Not Write Below This Line

____________________ ____________________ ____________

Signature of Permit Administrator Insurance Acknowledgement & Rating Date

lboice@citymb.info Application for Film Permit Page 3 of

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