City of White Plains Film Department
Film Set Questionnaire
THIS FORM MUST BE ACCOMPANIED BY FILM PERMIT APPLICATION
Film Production Title: Today's Date:
Applicant's Name Telephone Number:
Name of Production
Company:
Film Location:
Please identify any production processes, materials or conditions that may need special fire and/or life
safety attention from the White Plains Fire Department.
Describe any special effects that you will be incorporating in your scenes
Detail any scenes that require any special effects.
If necessary for safety, the White Plains Fire Department may require production alterations or on-
site mitigation measures.
Description of processes, material or conditions [include a site plan, if applicable]
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