Moving Vehicle and Storage Container Permit Application Department of Public Works 2100 Ridge Avenue Evanston, IL 60201 Dial 3-1-1 or (847) 448-4311 www.cityofevanston.org Moving Vehicle Parking FOR OFFICE USE ONLY Permit #: Permit Fee: $ Acc. No: 2630.52126 Approved by: Start Date: : Expires: Fee Schedule: $100 per location, per occurrence Storage Container Placement Moving/Storage Container Company Information: Co. Name: Contact Name: Phone: ( ) - Applicant Information: Name: Address: Phone: ( ) - Email: Date(s) the Permit requested for: @ thru Site Location (first): (Street, property address, or distance and direction from nearest public street intersection) Site Location (second, if needed): (Street, property address, or distance and direction from nearest public street intersection) On Site/Emergency Contact: Name: Phone: ( ) - Description (Please, provide all the information requested bellow): Right-of-Way Impact Number of Moving Vehicles/Storage Containers Length of the Moving Vehicle/Storage Container Meter Parking Information Street Parking*** Alley (linear feet) Meter Stall(s) # , , , Road__ _(Ave/St) Block # _ Metered*** , *** If you checked Metered Parking, fill in the inventory number(s) of meter stall(s), painted on the outer side, and name and block number of the road (Example ---- Meter Stall(s) # 0781, 0782 Road Sherman (Ave/St) Block # 1800). Nature of Activity/Additional Information: FOR STORAGE CONTAINER PERMIT APPLICATIONS ONLY (as required by the City Code). CERTIFICATE OF INSURANCE valid for permit period, with $1,000,000 general liability coverage and naming the “City of Evanston” as additional insured is to be submitted by the company, which provides the container(s) to the customer. Any changes to operations set forth in this application without the prior approval of the City Engineer, may result in citation and fine Permit Acceptance and Liability Waiver (to be signed by authorized company representative or homeowner) I request permission to excavate and/or occupy the public right-of-way in the City of Evanston in accordance with Section 7 of the City Code. For consideration of such permission, I agree to indemnify, hold harmless and defend the City of Evanston, its officers, agents and employees, from any and all claims resulting from injuries, including death, damages or losses, including, but not limited to the general public, which may arise or which may be alleged to have arisen out of, or in connection with such excavation and occupancy. I further agree to do all work in accordance with the conditions, regulations and city standards provided with this application. A copy of this permit shall be available for review at the job site at all times when work is occurring in the right-of-way. Signature: _ _ Date: Applicants signature or printed name if submitted by the email.