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INTERNATIONAL FIRE & BUII,DING CODES REVIEW COMIVIITTEE APPLICATION ~ The Paris City Council is seeking committed individuals who are dedicated to the well-being of the Paris community to serve 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 qualifica.tions may be mandated by statute, City Charter, ordinance, or resolution. Please complete the information requested below and retnrn by Monday, Augast 3, 2009, to: City Clerk, 150 First Street SE/P.O. Box 9037, Paris, Texas, 75461. Candidate Information Name: ~./!o`I f I FGi S hnh Adciress: T"X 7.5VA,2 Work Phone: /f/ ~i Home Phone: 5?43r - . F~: E-mail Address:~ ~~uc~~~►a fle~ 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, list dates of service on any City boards, commissions, or committees. ~Q e7 Atfa (~krZ-A ~h ~ (7 t Personal Backgronnd 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," descnbe your occupation or other appropriate background description. ❑ Alazm Contractor ❑ Historic District Property Owner ❑ Comnnercial Building Contractor ❑ Insurance Agent ❑ Downtown Property Owner ~ Other:&on.,) I e A cc _ti+ i zc Certification and AnthorizaNan ~n tki 5 By sigaing below, I aclmowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the Iaws of the State of Texas regatding nepotism and conflicts of interest of appointees to City boards, commissions, and committees. I also certify that if appoimed 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 commitbee 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 natification of topics of interest I certify dw the information given by me in this application is true and correct and any false information or misrepresentabon is sufficient gmunds for disqualification. I further affirm that I have uot prEdetennined a finaI opinion on the adoption of the International Building Code or Inwmational Fire Code and will approach commiitee deliberations and recommendations with an open and constructive mind. I suthorize the City of Paris to verify all information provided in tlus application. In accordance with Section 552 of the I.ocal Government Code, I understand that information provided ia this application may be available to the public upo est. Signature of Candidate: Date: r., For Citv C1erIE's Use Oniv ~ f~ Conflict of Interest: Y /N Indebtedness: Y/ N Neiwtiam: Y/ N Dist.: 12 3 4 5 6 T ~ i~ City of Paris Revised 7/18/w