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INTERNATIONAL FIRE & BUILDING CODES REVIEW COMMITTEE APPLICATION <br />The Paris Giry Council is seeking committed individuals who are dedicated to the well-being of the Faris <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, othei• aualifications may be mandated by statute, City Charter, ordinance, or <br />resolution. Please complete the infornlation 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 Infoxmation <br />N ame: 2~ M ~ <br />Address: ~ 4-A S~ <br />Work Phone: ;V_`~ Home Phone: ' /2 6 C 74, <br />Fax: E-mail Address: <br />Please note any special knowledge, education, or experience you have that is applicable to the function of <br />the committee (attach additional pages if necessary). If applicable, list dates of service on any City <br />boards, commissions, or commi tees. i <br />r/ i~t~ r ~ ~~e'r~~ -S <br />~1, e ~ J~ ~f ' <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 <br />Downtown Property Owner <br />Certification and Authorization <br />❑ Insurance Agent <br />❑ Other: <br />By signing below, I acknowledge that 1 am aware and agree to the prohibitions of the City of Paris Charter and the (aws of the <br />State of Texas regarding nepotism and contlicts of interest of appointees to City boards, commissions, and committees. I also <br />certify that if appointed 1 will attend at least 75 percent of all regular meetings and shall not have any delinquent indebtedness <br />to the City during my term. 1 understand that the number of positions on this cortunittee are limited and that I may not be <br />appointed; however, if 1 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 International 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 />applieation. ln aceordance ~ dkAo 52 of the Local Government Code, 1 understand that information provided in this <br />Si i on request. <br />, <br />appl~icadonature of may be Cand availabl u i <br />ida <br />Date: <br />For Citv Clerk's Use Onlv <br />Conflict of Interest: Y/ N Indebtedness: Y/ N Nepotism: Y/ N Dist.: 1 2 3 4 5 6 7 <br />Cihr of Paris Revised 7/18l09 <br />7 (6 C~ <br />AUG "i `Q3 AN.I l ;'j I <br />. <br />