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iNTF.12NAT1ONAI. b'tRF & St~I Lu1NG CUD~'~S REVIEW COMMIT'TEE APk'L1C;ATION <br />'T'he F4ris C:ity ('csuncil is seeking committed individuals who are dedicated tu thc w~ll-bcing of the Paris <br />community tio serve cm an ad hoc commiitee to review the International Building nd Fire Codes and <br />consider recommendations for adoption by the C'ouncil. In addition to the general yi~alificaticins litited in <br />the certificatiem below, other yualifications may he rtlandated by Slatute, City C11arter, ardinanee, or <br />re5oluticm. I'lease complete the information request.ed bclow and return by Mond~y, Angust 3. 2004, <br />to: City Clerk, 150 First Street Sl.;/Y.U. I3ox 9037, Paris, Tcxas, 75461. <br />(:andidate InTnrona(ion <br />Namc: J <br />Addres5 <br />~ <br />c~~_- Home Phcroe: ~~C.~ ) 7%trr ~ <br />Work Phnne: i <br /> <br />Fax: F.-mail Address: <br />V'~', ) <br />Nlease notc ariy spc;citil knawtecige, educAtion, or expcrience you havc that is applicale tc~ the Function of <br />the cotnmiltee (ailxch additional pagcs if necessary). [C applicable, ii4t dates ot'~ervice on any City <br />kxoards, commissinns, or committees. ' <br />6_ <br />t, tt.iy.~ C--.\~l 1~~.1Yrt~..tiTa.~ I< <br />Perwnal Rackgr+ound <br />The City Counci► is iiiterestcd in appainting rnemhers with ageneral interest in thc bu~itdinb and fire codes <br />bul alscr recc}gnizCy the need to havi; members with specialized knowlcdse. Please; c eck the appmpriate <br />box below a.nd for "[]ther," describe your ocGUpation or othcr appropriafe backgrounc~description. <br />Alarm Contractor ❑ i lis#oric Uistrict Propcrty bwncr <br />~ Cnmmercial 13uilding Coniractor ❑ Insura.ncc ngcnt <br />❑ 1]owntown Propcrty Owner ❑ Uther;_._„_ ; <br />Ccrtificatioa and Authorizatinn <br />Ky signittg beluw. 1 euknowlcdge that I am aware and lgrze tki the prohibilions of'thc CiYy of Paris CCf~arter and the laws of ttie <br />Slxzle of'['exas rcgarding nepotism aEid G4nfliCts of interesi ol'appoinlccs to City hc>ards, commissinisSi and committees. L a15a <br />Lcrtify thxt if appointed I will attend At least 75 pcrcent of sil regular meetings and shall not have any dClinyucnt indcbtcdncss <br />to the ity during Itry Icrni. 1 undcrstxnd that the number of positions nn this eumittillce tue limiteld and that I may not be <br />appcrinted; ftownvrr, il` 1 xm nut xppointed, I agrea tn be plACed in a database for possiblc lulurc otification of topics of <br />ittleresl. I ccrtify that thc informatipn giuen by me in this appliuation is true and correct snd ~ny false informatiott pr <br />misrepresentatian is 3ufficient $rnutids Por disqualiCcalion f ti►rthcr affirm that 1 have not predetennijed a fina) opinion on the <br />adoptinn of the lnternationxl 13uiiiling C.odc ur Imernational Fire C'ode and will apprpadi cont ittee deliberatiuns and <br />recammendatiuns wish an upen snd cnnshvctive mind. 1 autharize the City of Faris to vcriE'p all inS' ation provided in this <br />applicatiun, in accnrdanca with Section 552 0l the Lix;a1 Guvcrnment C:odc, f understand that infnt m3tion provided itt this <br />application may bc availahle tn the public upun r• <br />1 l,y zi <br />,ignature of Candidatc:_`7~~ Datc: <br />Eor.Uty 't r 's Npk d 1 <br />Cuntiict of interast: Y/ 2V lndebteclness: Y/ N Nepatism: Y/ N Dist.: I 2 3 4 5 C 7 <br />i <br />Rcviwd 7118/09 <br />Cfiy of P„ris <br />- - ~ 2 5 <br />i0' d 508Z 58L E06 SL..AQd 001 E.AES dEZ = ZO 60-Ei-f5nH <br />