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2. Company Name*
4. Company Address*
6. City*
7. State*
8. ZIP Code*
10. Phone Number*
12. Name of Person Coordinating Location*
14. Address*
16. City*
17. State*
18. ZIP Code*
20. Phone Number*
21. Email*
23. Location(s) of Production*

    Be as specific as possible, i.e., street, intersection.

25. Will you require a closed set?*

    1. Yes
    2. No
27. Dates of Production*
    Dates of Production Start Date

    —

    Dates of Production End Date
28. Hours of Production*
    Hours of Production Start Time

    —

    Hours of Production End Time
30. Additional Dates of Production
    Additional Dates of Production Start Date

    —

    Additional Dates of Production End Date
31. Additional Hours of Production
    Additional Hours of Production Start Time

    —

    Additional Hours of Production End Time
33. Number of People Involved/Crew*
34. Number of Vehicles Onsite*
36. Brief Description/Type of Production*
38. Anticipated Use of City Resources and/or Workforce*
40. Brief Description of Anticipated Street or Sidewalk Closures*

    Include time of day, hours and duration.

42. By submitting this application, the applicant agrees to promptly reimburse the City for any extraordinary expenses incurred in connection with the production. These expenses may include, but are not limited to, costs associated with personnel and equipment required to support the production. An estimate of these costs will be provided to the applicant prior to the issuance of the permit. Please note: the City is not obligated to provide personnel or equipment. Requests for such resources may require approval from the City Council.

44. Printed Name*
45. On Behalf of (Company Name)*
47. Checking this box acts as your signature:*

    1. Signature
48. Date*
    Date
50. Disclaimer

    Please Note: Lakeville is home to many beautiful parks and we’re proud to share them with our community. However, all filming on park property must be pre-approved by the City. Some park locations may already be reserved or unavailable at certain times. Be sure to submit your request in advance to ensure availability.

Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field