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2. Master Film Permit
4. FILM PERMIT APPLICATIONS MUST BE SUBMITTED ELECTRONICALLY VIA THIS FORM
6. Film Permit #:
   City use only
7. Production Dates:*
   Production Dates: Start Date

   —

   Production Dates: End Date
9. Project Name:*
11. Production Company Name:*
12. Local?*

    1. Yes
    2. No
14. Client Name:
    If applicable
15. Local?

    1. Yes
    2. No
17. Agency Name
    If applicable
18. Local?

    1. Yes
    2. No
20. Authorized Agent
22. The company named above agrees to pay all costs for required permits and film coordination services provided by the City of Everett as described in the Application and Film Permit for Street Use. This includes revenue foregone and costs for Film Permits for street use, parking meter hoods, traffic control, removal and installation of street fixtures, use of street and/or sidewalk barricades and like activities as required.
    
    In addition, the company named above agrees to pay a $500.00/$1000.00 deposit, refundable upon final inspection of the film location and verification that all obligations to the City incurred as a result of this activity are satisfied. The company agrees that the City staff time and materials required to restore the location to its previous condition will be deducted from the deposit. The company further agrees to pay the City of Everett for restoration costs in excess of the deposit amount. In addition, the company named above agrees to secure and maintain in full force and effect during the full term of the permit, comprehensive general liability insurance as described in the Everett Film Manual and Instructions, which by this reference are incorporated herein.
    
    Indemnification: The permittee shall indemnify and hold harmless the City, its officers, elected officials, agents, employees and volunteers, from and against any and all claims, actions, suits, proceedings, costs, expenses (including reasonable attorney's fees), damages, and liabilities claimed by any person, organization, association, or otherwise arising out of or relating to any act or omission of the permittee, its agents, contractors or employees under this Agreement. Such indemnification shall not be effective to the extent that the damage or injury results from the sole negligence of the City. The indemnification provided for in this permit shall survive any termination or expiration of this Agreement.
    
    Insurance: The Insurance provisions of the City's current Master Film Permit Manual are hereby incorporated by reference and shall apply.
    
    Failure of the Company to comply with the terms of the City's permit as described may result in revocation of the permit and the inability to obtain future permits.
    
    Permit not valid without signatures of Authorized Agent and the Everett Film Office.
24. Authorized Agent:
25. Title:
26. Date:
28. By checking this box as an electronic signature, I agree to all the terms and conditions that may apply to the Everett film permitting process and agree that all information contained in this application is true and correct to my knowledge.

    1. I agree
30. FOR CITY USE ONLY
    Film Office Approval:
    Deposit amount: $
    Date:
    Insurance:
34. Contact and Production Information for Master Film Permit
36. COMPANY INFORMATION
38. Production Company Name:*
40. Address:*
42. City:*
43. State:*
44. Zip Code:*
45. Phone:*
47. Production Web Address:*
49. Billing Contact:*
50. Email:*
52. Billing Address:*
54. City:*
55. State:*
56. Zip Code:*
57. Phone:*
59. Anyone engaging in business within the Everett city limits needs a business license. More information available at www.everettwa.gov.
61. PRODUCTION CONTACT INFORMATION
63. Producer:*
64. Phone:*
65. Email:*
67. Production Manager:*
68. Phone:*
69. Email:*
71. Location Manager:*
72. Phone:*
73. Email:*
75. Asst. Location Manager:
76. Phone:
77. Email:
79. PRODUCTION INFORMATION
81. Number of Crew
83. Local:*
84. Total:*
86. Number of Talent
88. Local:*
89. Total:*
91. Anticipated Number of Public Locations:*
92. Number of Production Vehicles:*
94. Total Number of Filming Days in Everett:
95. Total Number of Filming Days:*
97. Total Production Budget:*
    -- Select One --$0-$10,000$10,001-$50,000$50,001-$150,000$150,001-$500,000$500,001-$1 million$1 million-$5 millionOver $5 million
98. This information is critical for reporting the economic impact of film activity in Everett. It will be held strictly confidential and only reported in aggregate with other production budget information.
100. Brief description of the project: (250 character limit)*
102. The project is: (check all that apply)*

     1. Feature Film
     2. Short Film
     3. Web Series
     4. PSA

     1. Still Photography
     2. Music Video
     3. Kiosk
     4. Student Film

     1. Interactive/Game
     2. Regional
     3. TV Programming
     4. Corporate/Industrial

     1. National
     2. Commercial/ Advertising
     3. Documentary
     4. International
103. Other as specified:
105. Additional services: (check all that apply)

     1. Police
     2. Fire

     1. Port of Everett
     2. Parks

     1. Water Permit
     2. Noise Variance

     1. Explosives Permit
107. Equipment or props that may be present at any of your shooting locations: (check all that apply)*

     1. Generator
     2. Rig (stills)
     3. Light

     1. Effects
     2. Crane
     3. Large prop

     1. Track
     2. Set Design
     3. Dolly

     1. Water Truck
     2. Camera Car
109. Other equipment or props:
111. You must complete a completed Location Form for each of your public filming locations. Download at (Link here)
Leave This Blank:


113. 1. Receive an email copy of this form.
114. Email address

     This field is not part of the form submission.

115. Submit Submit and Print

* indicates a required field