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INTERNATIONAL FIRE & BUILDING CODES REVIEW COlVIM1TTEE APPLICATION The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to seive 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 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 return by Monday, August 3, 2009, to: City Clerk, 150 First Street SE/P.O. Box 9037, Paris, Texas, 75461. Candidate Information Name: Address: ;,1 % r'l~ /`~''~L ~✓'i - Work Phone: °J:, 3- 7 j?c, S' Home Phone: c7 ` `l " ~ ~ Fax: E-mail Address: rf=L1° 4C o.-s-b-!y Please note any special knowledge, education, or experience you have that is applicable to the function of the committee (attach additional pages if necessary). If applicable, ]ist dates of service on any City boards, commissions, or committees. . . 0.1 17 G . I ~r7tI ~J 47Z' I , :j U,~ YK1%V ~vu yl ~ 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 bax below and for "Other," describe your occupation or other appropriate background desci7ption. ❑ Alarm Coniractor ❑ Commercial Building Contractor Q Downtown Property Owner Certification and Authorization ❑ Historic District Property Owner ❑ Insurance Agent ❑ Other: By signing below, I acknowledge that 1 am aware and agree to the prohibitions of the City of Paris Gharter and the (aws of the State of Texas regarding nepotism and contlicts of interest of appointees to City boards, commissions, 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. 1 undeistand that the number of positions on Xhis committee are limited and that I may not be appointed; however, if I am not appointed, I agree to be placed in a database for possible future noCification of topics of interest. 1 certify that the information given by me in this applieation is true aud 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 Building Code or International Fire Code and will approach committee deliberations and recommendations with an open and constructive mind. I authorize the City of Paris to verify all information provided in this application. ln accordance ~vrith Section 552 of the Local Goveenment Code, I understand that information provided in this ,~c upon request. application may be available to the pub Signature of Candidate: Date: 9 ' ' ~ For Citv Clerk's Use Onlv Conflict of Interest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: 12 3 4 5 6 7 City of Paris Revised 7/18/09 _ ' 2 5 1j f=►Ui; 10 109 qh±1 l : 21