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City of Salem Massachusetts INSPECTIONAL SERVICES City Hall Annex 98 Washington Street, 2nd Floor Salem, MA 01970 [PHONE REDACTED] Doc. Rev. 10/16/23 PERMIT CANCELLATION REQUEST FORM Permit No.: Property Address: Original Applicant’s Name: I am requesting the following action to the permit listed above: Cancel Permit (if permit has been issued the permit fee is non-refundable) Reason for Date: Homeowner Signature: Contractor Signature: Required for if Contractor is requesting removal from the project.