1 2/2013
City of Marco Island Building Services Division
Citizen Access Portal
Password Security Acknowledgement
This form is a requirement of the online permitting and eReview services provided by the City of
Marco Island Building Services Division.
Acknowledgement Date:
License Holder Name:
Licensed Company Name:
Email Address and User name
User Name Email Address Submit by portal or email Y or N
*E-mail for automated inspection results:
*Only one e-mail is permitted for this purpose.
By completing this form I am acknowledging that it is my responsibility to maintain the security
of any login details for accounts for the City of Marco Island Citizen Access Portal.
This includes changing the password periodically and checking the Citizen Access Portal to see
what permits are listed. In lieu of checking the portal for the list of permits, a data export can be
provided upon request.
Print Name of Qualifier Signature of Qualifier
State of Florida
County of
The foregoing instrument was acknowledged before me this day of , 20 ,
by ,
who is personally known to me or has produced as
identification.
Signature, Notary Public – State of Florida
(Seal)
Printed, Typed, or Stamped Name of Notary
