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INTERNATIONAL FIRE & BUII.DING CODES REVIEW COMIVIITTEE APPLICATION The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to serve on an ad hoc committee to review the Intemational Building and Fire Codes and consider recommendstions for adoption by the Council. In addition to the general qualifications listed in the certification below, other qualifications may be mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested below and retarn by Monday, Angast 3, 2009, to: City Clerk, 150 First Street SElP.O. Box 9037, Paris, Texas, 75461. Candidate Information Name: LiDhn /~L! 5 h-) a Address: /~lir~Jrl~nl 1~r'T~~~'►~~ 7'X 'T..SZZA~Z Work Phone: it/ i4 Home Phone: r-5 +n 41 0 --w c U e-7~ih Fax: E-mail Address: _ *Q-- Please note any special lnowledge, education, or experience you have that is applicable to the function of the committee (attach additional pages if necessary). If applicable, list dates of sexvice on any City boards, commissions, or committees. -2:S-C7-e7~ Aftcl (A1 ci St ) C~ Q t Personal Backgronnd The City Council is interested in appointing members with a general interest in the building and fire codes but also recognizes the nced to have members with specialized lrnowledge. Please check the appropriate box below and for "Other," descnbe yovr occupation or other appropriate background description. ❑ Alarm Contractor ❑ Historic Disirict Property Owner ❑ Commercial Building Contractor ❑ Insurance Agent ❑ Downtown Property Owner MQther:~lb'2,~ Certification and Anthorization ~r) +tq i 5 1-5 L' c t By sigaing below, I aclmowledge that I am awan snd agee to the prolubitions of the City of Paris Chatter and tle laws of the State of Texas regardin8 nepotism and con8icts of interest of appoiidees to City boards, commissions, and c;ommittees. I also certify that if appointed I will atbead at least 75 percent of all regutar meetings and shall not have any delinquent indebtedness to the City during my Lerm. I undeistand thst the numler of positions on this committee are limited and thst I may not be appointed; however, if I am not appointed, I agree to be placod 'm a dstabase for possible future notificabon of topics of interat. I catify that the information given by me in this application is true and oorrect and any false information or misrepresenadon is sufficient grounds for disqaalification. I fiuther affum thst I have not predebermined a final opinion on the adophon of the Iuemstional Build'mg Code or Inbernational Fire Code and will appmach oommittee deliberations and recommendations with an open and consmwdve mind. I authoriz$ the City of Paris to verify all information providod in this aPPlicatiwn. In sccordanoe with Saxion 552 of tbe L,ocal Governmeflt Code, I tmdwsbnd Wat informsfim prnvided in this application may be available to the pnblic upo"quesL Signature of Candidate: nate: ~ For Citv Qerk's Use 0~1+~ c" Conflict of Interest: Y/ N Indebtefteaa: Y/ N Nepotism: Y/ N Dist.:12 3 4 5 6 7 ~ City of Paris - --y195