LOS ANGELES FIRE DEPARTMENT Bureau of Fire Prevention & Public Safety
FILM UNIT 200 N. Main Street, Suite 1710 Los Angeles, CA 90012 (213) 978-3670
Email request to: lafdfilm@lacity.org
Subject line of the email shall be formatted as follows: Fire Performer Request [1st Date of Work] [Address] * EXAMPLE: Fire Performer Request 10/21/15 200 N Main St
FIRE PERFORMERS APPLICANT Permit Applicant Business Name :
Applicant 1: Last Name (Legal Name Required)
Ml
First Name
Stage Name (If Applicable)
Applicant 2: Last Name (Legal Name Required)
Ml
First Name
Stage Name (If Applicable)
If additional applicants, please attach an additional page(s) with names listed. Mailing Address City State I Country
Street Address (if different from above) Email
Phone No. - ext. City
I
Zip Code Zip Code
State
Event Sponsor/Promoter
Business Name:
Contact Person : Last Name Mailing Address Phone No. 1 Phone No. 2 -
First Name
Ml
City
State
ext.
Email Address
ext.
Date & Time of Fire Performance
Venue Description
I
Zip Code
Venue Name:
On Site Contact Person:
On Site Contact Phone Number:
Venue Street Address
City
Zip Code
Event Description:
Describe the location of the hazard area within the venue:
Is the Performance Indoors or Outdoors
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Stage/floor materials Concrete
I I
Ceiling/overhead clearance 7-10 Feet
I I
Outdoors J Wood 10-15Feet
I I
I
I I
Tile 15-20 Feet
I I
Venue Phone No. -ext.
I I
Indoors Other 20 + Feet
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