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INTERNATIONAL FIItE & BUILDING CODES REVIEW COMMITTEE APPLICATION <br />The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris <br />community to serve on an ad hoc committee to review the International Building and Fire Codes and <br />consider recommendations for adoption by the Council. In addition to the general qualifications listed in <br />the certification below, other qualifications may be mandated by statute, City Charter, ordinance, or <br />resolution. Please complete the information requested below and return by Monday, August 3, 2009, <br />to: City Clerk, 150 First Street SE/P.O. Box 9037, Paris, Texas, 75461. <br />Candidate Information <br />Name: <br />Address: <br />~ V~. trs <br />Work Phone: Home Phone: 7~ ~ `1 7Z(D <br />Fax: 12-1 E-mail Address: 'Lk tP.t t'(6~ ~"6.Pa, ~S , C-D vr•/ <br />~ <br />Please note any special knowledge, education, or experience you have that is applicable to the function of <br />the committee (attach additionai pages if necessary). If applicable, list dates of service on any Lity <br />boards, commissions, or committees. <br />Personal Background <br />The City Council is interested in appointing members with a general interest in the building and fire codes <br />but also recognizes the need to have members with specialized knowledge. Please check the appropriate <br />box below and for "Other," describe your occupation or other appropriate background description. <br />❑ Alarm Contractor ❑ Historic District Property Owner <br />❑ Commercial Building Contractor ❑ Insurance Agent <br />❑ Downtown Property Owner [:?/Other: b Av\, Vf,~ <br />Certification and Authorization <br />By signing below, I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the <br />State of Texas regarding nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also <br />certify that if appointed I will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness <br />to the City during my term. I understand that the number of positions on this committee are limited and that I may not be <br />appointed; however, if I am not appointed, I agree to be placed in a database for possible future notification of topics of <br />interest. I certify that the information given by me in this application is true and correct and any false information or <br />misrepresentation is sufficient grounds for disqualification. I further affirm that I have not predetermined a final opinion on the <br />adoption of the Intemational Building Code or International Fire Code and will approach committee deliberations and <br />recommendations with an open and constructive mind. I authorize the City of Paris to verify all information provided in this <br />application. In accordance with Section 55 f the Local Government Code, I understand that information provided in this <br />application may be available to the public u o equ st. Date: <br />Signature of Candidate: <br />For Citv Clerk's Use Onlv <br />Contlict of Intereste Y/ N Indebtedness: Y/ N Nepotism: IT / N Dist.c 12 3 4 5 6 7 <br />I I L 1tc`) <br />City of Paris Revised 7/18/09 <br />