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INTERNATIONAL FIRE & BUILDING CODES REVIEW COMMITTEE APPLICATION The Paris City Council is seeking cominitted individuals who are dedicated to the well-being of the Paris community to setve on an ad hoc committee to review the International Building and Fire Codes and consider recommendations for adoption by the Council. In addition to the general qualifcations listed in the certification below, other qualifications may be mandated by statute, City Charter, ordinance, or resolurion. Please complete the information requested below and return by Monday, August 3, 2009, to: City Clerk, 150 First Street SE/P.O. Box 9037, Paris, Texas, 75461. Candidate Information Name: C Address: S-T " rG~ \-t- iO ( Home Phone: Work Phone( Z35 - 1 2y Fax: ~S ~G _ 9`.~ cf`- ~ 1c 7 E-mail Address: I e~' c 0 (J ~ L t T~'YY) ,+~)''E~~, C'~0 Please note any special knowledge, education, or experience you have that is applicable to the function of the cornmittee (attach additional pages if necessary). If applicable, list dates of service on any City boards, commissions, or committees. Vf:7- - - ~--~~-YI.3 4 Personal Background The City Council is interested in appointing members with a general interest in the building and fire codes but also recognizes the need to have members with specialized knowledge. Please check the appropriate box below and for "Other," describe your occupation or other appropriate background description. ❑ A1arm Contractor ❑ Commercial Building Contractor 2176-wntown Property Owner Certification and AuthorizaHon ❑ Historic District Property Owner ❑ Insurance Agent ❑ Other: By signing below, I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of Che State of Texas regarding nepotism and conflicts of interest of appointees to City boards, coinmissions, and committees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness to the City during my term. I understand that the number of positions on this committee are Iimited and that I may not be appointed; however, if 1 am not appointed. I agree to be placed in a database for possible future notification of topics of interest. 1 certify that the information given by me in this applicatioil is true and correct and any false information or misrepresentation is sufficient grounds for disqualification. I further affirm that I have not predetermined a final opinion on the adoption of the International Buri ng Code or International Fire Code and will approach co~nmittee deliberations and recommendations witli an oPenand~onstructive mind. Yauthorize the City of Paris to verify all information provided in this application. ln accordance,with SePion 552 ofAe L,bcal Government Code, I understand that inforinati~n provided in this que~ti ~ ~ application inay be available to the,public up ti ~ Signature of Candidate: ' ~ - Date: ~ For Citv Clerk's Use Onl Conflict of lnterest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: 12 3 4 5 6 7 City of Paris Revised 7/18/09 . ---25i