CITY OF MESA FILM PERMIT “LOCATION WORKSHEET”
PRODUCTION TITLE: FILMING DATE (s):
_______________________________________________________________________________________
________________________________Time(s): Set-up:__________Film:______Wrap:________
LOCATION OF FILMING:________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
Location Detail: (check all that apply) ___Residential Property ___Public Right-of-Way ___Commercial Property ___On-Street Parking ___Governmental Property ___Private Property (w/pyro)
SUMMARY OF SCENE: __________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________
Scene Requirements: (check all that apply) □ Road Closures □ Lane Closures □ Interior Dialogue □ Exterior Dialogue □ I.T.C. (3-5 min. max) □ Running Shots □ Police Escort □ Pedestrian Disruptions □ Drive Bys □ Drive Ups/Aways □ Camera in Curb Lane □ Camera on Sidewalk □ Tow Shots □ Cranes □ Wet Down □ Dolly Track □ Drive w/Traffic Flow □ Scaffolding/Platforms □ Other Special Conditions/Requests:___________________________________________________________________________________ Special Effects: (Pyrotechnics, open flames, smoke, laser equipment) Contact: Mesa Fire Prevention @ 480-644-2622 DESCRIBE:_______________________________________________________________________________________________________
Cast/Crew (REQUIRED)__________
Staging Area/Location:__________________________________________________ No. vehicles/equipment: Cars/Vans_____ Trucks_____ Motor Homes_____ Camera Cars _____ Catering/Other_____ Parking Meters Required: YES____ NO____ STYLE: Locked/Tie-on Amt. Pd.:_____________ Receipt #:_________________________ Meter #’s/Location___________________________________________________________________________________________________ __________________________________________________________________________________________________________________ NOTE: Recommend posting of “No Parking” Signs required 24-hours in advance of call time
APPROVALS AND SPECIAL REQUIREMENTS (FOR OFFICIAL USE ONLY)
MESA POLICE DEPT:_______________________________________________________________DATE:_______________
Special Requirements: ______POLICE OFFICERS REQUIRED ______POLICE OFFICERS REQUIRED AT FSE DISCRETION
__________________________________________________________________________________________________________________
MESA FIRE DEPT.: (if applicable)______________________________________________________________DATE:_______________
Special Requirements: _______________________________________________________________________________________________
CITY OF MESA: ____________________________________//______________________________DATE:_______________
Tax & Licensing City Manager Special Requirements:_______________________________________________________________________________________________
ALL filming at the Mesa Arts Center Campus or any City of Mesa Commercial Facility requires a Location Agreement and approval from the FILM COORDINATOR: E-mail: Kimberle.west@cityofmesa.org OFFICE: 480-644-4600 FAX: 480-644-5582 DISTRIBUTION: APPLICANT AZ FILM OFC MESA PD FIRE PREVENTION FILE CITY ATTORNEY’S OFFICE TAX/LICENSING
FSE (Film Coordinator)